title: Effect-site concentration of remifentanil for minimizing cardiovascular changes by inhalation of desflurane.
abstract: OBJECTIVE
  This study aims to investigate the most appropriate effect-site concentration of remifentanil to minimize cardiovascular changes during inhalation of high concentration desflurane.
  
  
  METHODS
  Sixty-nine American Society of Anesthesiologists physical status class I patients aged 20-65 years were randomly allocated into one of three groups. Anesthesia was induced with etomidate and rocuronium. Remifentanil was infused at effect-site concentrations of 2, 4 and 6 ng/mL in groups R2, R4 and R6, respectively. After target concentrations of remifentanil were reached, desflurane was inhaled to maintain the end-tidal concentration of 1.7 minimum alveolar concentrations for 5 minutes (over-pressure paradigm). The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and end-tidal concentration of desflurane were measured for 5 minutes.
  
  
  RESULTS
  The end-tidal concentration of desflurane increased similarly in all groups. The SBP, DBP, MAP and HR within group R4 were not significantly different as compared with baseline values. However, measured parameters within group R2 increased significantly 1-3 minutes after desflurane inhalation. The MAP within group R6 decreased significantly at 1, 2, 4, and 5 minutes (p<0.05). There were significant differences in SBP, DBP, MAP and HR among the three groups 1-3 minutes after inhalation (p<0.05). The incidence of side effects such as hyper- or hypo-tension, and tachy- or brady-cardia in group R4 was 4.8% compared with 21.8% in group R2 and 15.0% in group R6.
  
  
  CONCLUSIONS
  The most appropriate effect-site concentration of remifentanil for blunting hemodynamic responses by inhalation of high concentration desflurane is 4 ng/mL.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Armed Forces Capital Hospital, Seongnam, Korea.
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Jeong
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Baik
authors.forename: Jong Hak
authors.initials: JH
authors.lastname: Kim
authors.forename: Youn Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jae Hyon
authors.initials: JH
authors.lastname: Bahk
mesh_terms: D000328:Adult; D000368:Aged; D000732:Androstanols / Q000009:adverse effects / Q000494:pharmacology; D000777:Anesthetics / Q000009:adverse effects / Q000494:pharmacology; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D000077335:Desflurane; D005045:Etomidate / Q000009:adverse effects / Q000494:pharmacology; D005260:Female; D006321:Heart / Q000187:drug effects*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use*; D020011:Protective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000077208:Remifentanil; D000077123:Rocuronium
chemical_list: D000732:Androstanols; D000777:Anesthetics; D018685:Anesthetics, Inhalation; D010880:Piperidines; D020011:Protective Agents; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil; D000077123:Rocuronium; D005045:Etomidate
keywords: Remifentanil; desflurane; hemodynamic change
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