title: Low and moderate remifentanil infusion rates do not alter target-controlled infusion propofol concentrations necessary to maintain anesthesia as assessed by bispectral index monitoring.
abstract: BACKGROUND
  We investigated whether the EC(50) (the effective concentration that is required to achieve a response in 50% of patients) of propofol necessary to lower the Bispectral Index (BIS) value to 50 or less was reduced by coadministration of different remifentanil infusion rates.
  
  
  METHODS
  Seventy-two adult ASA I or II patients undergoing endotracheal intubation and target-controlled infusion (TCI) propofol anesthesia were allocated to six groups by stratified randomization. Group B received remifentanil 0.1 mug x kg(-1) x min(-1), Group C 0.15 microg x kg(-1) x min(-1), Group D 0.2 microg x kg(-1) x min(-1), Group E 0.3 microg x kg(-1) x min(-1) and Group F 0.4 microg x kg(-1) x min(-1). Group A served as control and received no remifentanil. The response of the first patient to propofol TCI at 4 microg/mL determined the effect-site concentration of propofol for the next patient in the same remifentanil group (Dixon's "up-and-down" method). If BIS was >50, the next patient received more propofol, and if BIS was < or =50, the next patient received less propofol. The hemodynamic effects of the combinations were also studied.
  
  
  RESULTS
  The EC50 varied from 2.4 to 2.9 microg/mL. No additive effect of remifentanil on the EC50 of propofol was observed. However, there was a wider variation in the response to propofol when the patients received no remifentanil. There was a decrease in heart rate in the remifentanil groups.
  
  
  CONCLUSIONS
  Infusion of remifentanil did not reduce propofol requirements in the unstimulated anesthetized patient. Propofol TCI levels should not be reduced because remifentanil is coinfused.
authors.affiliation: Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia. lpwang@iinet.net.au
authors.forename: Lars P
authors.initials: LP
authors.lastname: Wang
authors.forename: Peter
authors.initials: P
authors.lastname: McLoughlin
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Paech
authors.forename: Irina
authors.initials: I
authors.lastname: Kurowski
authors.forename: Emma L
authors.initials: EL
authors.lastname: Brandon
mesh_terms: D000328:Adult; D000368:Aged; D000771:Anesthesia, Intravenous / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D016503:Drug Delivery Systems / Q000379:methods*; D004569:Electroencephalography / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010880:Piperidines / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage* / Q000097:blood; D000077208:Remifentanil
chemical_list: D019162:Anesthetics, Combined; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol