title: Total intravenous anaesthesia with high-dose remifentanil does not aggravate postoperative nausea and vomiting and pain, compared with low-dose remifentanil: a double-blind and randomized trial.
abstract: The study was designed to investigate postoperative nausea and vomiting (PONV) in low- and high-dose remifentanil regimens for total intravenous anaesthesia (TIVA) in adult female patients with American Society of Anaesthesiologists physical status classification I undergoing local breast excision. Propofol and remifentanil 5 ng · mL(-1) (L group) or 10 ng · mL(-1) (H group) were administered for anaesthesia induction and maintenance. Propofol was titrated within range of 0.1 μg · mL(-1) to maintain bispectral index (BIS) values between 40 and 60. Haemodynamic parameters during the intra- and postoperative periods and 24 h postoperative visual analogue scale (VAS) and PONV were evaluated. Each group with 63 patients was analyzed. The H group showed higher use of remifentanil and lower use of propofol, with similar recovery time. Mean systemic arterial blood pressure (MBP), heart rate, and BIS did not differ significantly before and after endotracheal intubation in the H group. However, significant increases in MBP and BIS were apparent in the L group. Postoperative VAS, PONV incidence and scale, and Rhodes index did not differ significantly between the two groups. In conclusion, TIVA with high-dose remifentanil did not aggravate PONV with similar postoperative pain, compared with low-dose remifentanil. Furthermore, high-dose remifentanil showed more haemodynamic stability after endotracheal intubation. This trial is registered with KCT0000185.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea ; Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Seong-Hyop
authors.identifier: 0000-0001-7764-9818
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Chung-Sik
authors.initials: CS
authors.lastname: Oh
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Tae-Gyoon
authors.initials: TG
authors.lastname: Yoon
authors.affiliation: Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Min Jeng
authors.initials: MJ
authors.lastname: Cho
authors.affiliation: Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Yang
authors.affiliation: Post-Anaesthetic Care Unit, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hye Ran
authors.initials: HR
authors.lastname: Yi
mesh_terms: D000328:Adult; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D010146:Pain / Q000209:etiology*; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000209:etiology*; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000077208:Remifentanil
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol