title: [Blocking effect of remifentanil on sympathetic response to tracheal intubation during sevoflurane anesthesia].
abstract: BACKGROUND
  We examined the hemodynamic responses to tracheal intubation during anesthetic induction by inhalational sevoflurane with continuous administration of remifentanil.
  
  
  METHODS
  This study enrolled 30 ASA physical status 1-2 patients, aged 20-65 undergoing elective surgical procedure. Anesthesia was induced with 5% sevoflurane in all patients, and then adjusted to maintain BIS values ranging from 40 to 60. Remifentanil at the rate of 0.5 microg x kg(-1) x min(-1) was administrated continuously, and tracheal intubation was performed by each anesthesiologist, at various times after administration of remifentanil. We recorded blood pressure (BP), heart rate (HR) and the duration between the initiation of an administration of remifentanil and a tracheal intubation (DRI). Sympathetic response to tracheal intubation was defined as more than 20% increase in either BP or HR at the intubation compared with that at preintubation. We analyzed the P50, representing the duration of remifentanil infusion with 50% probability of blocking sympathetic response to tracheal intubation.
  
  
  RESULTS
  DRI for individual patients varied from 77 sec up to 660 sec. According to the present data, P50 was calculated as 210 +/- 16.4 sec (mean +/- SD).
  
  
  CONCLUSIONS
  During sevoflurane anesthesia, remifentanil infusion at 0.5 microg x kg(-1) x min(-1) for more than 210 sec could provide the effective blocking of the sympathetic response to tracheal intubation with more than 50% probability.
authors.affiliation: Department of Anesthesia, Self Defense Force Naha Hospital, Naha.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Nakagaki
authors.forename: Manabu
authors.initials: M
authors.lastname: Kakinohana
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sugahara
mesh_terms: D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D017558:Elective Surgical Procedures; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D007442:Intubation, Intratracheal; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D000077208:Remifentanil; D000077149:Sevoflurane; D013564:Sympathetic Nervous System / Q000187:drug effects; D013997:Time Factors; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil