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Anesthetic Pharmacology
Anesthesia and Pain Medicine 2010;5(4):295-300.
Published online October 31, 2010.
Effect-site concentration of remifentanil to blunt the hemodynamic changes during rapid sequence intubation
Young Min Lee, Jeoung Hyuk Lee, Junyong In, Younsuk Lee, Myung Ha Yoon, Woong Mo Kim
1Department of Anesthesiology and Pain Medicine, Ilsan Hospital, College of Medicine, Dongguk University, Ilsan, Korea.
2Department of Anesthesiology and Pain Medicine, Chonnam National University, Medical School, Gwangju, Korea.
3Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
This study was undertaken to evaluate the effect-site concentration of remifentanil to blunt the hemodynamic changes during rapid sequence intubation.
Eighty patients were enrolled and divided into four groups being assigned with different effect-site concentrations (Ce)of remifentanil of 0, 2, 3, or 4 ng/ml. Patients arrived at the operating room without premedication and their baseline vital signs were recorded. With preoxygenation of 100% O2, remifentanil was infused by target controlled infusion according to patient group. After achievement of a stable level of Ce, propofol 2 mg/kg and rocuronium 1.2 mg/kg were injected and the trachea was intubated one minute later. Hemodynamic changes were recorded at 1, 2, and 3 min after remifentanil infusion, immediately before and after endotracheal intubation, and 1 and 2 min after endotracheal intubation.
The 50% effective Ce of remifentanil was 1.4 ng/ml (95% confidence interval, CI: 0.9-1.8) to blunt the increase of mean blood pressure and was 2.4 ng/ml (95% CI: 1.6-3.1) to blunt the increase of heart rate. The 50% Ce for the decrease of mean blood pressure was 2.8 ng/ml (95% CI: 2.2-3.4).
During the rapid sequence intubation, the 50% effective effect site concentration of remifentanil to prevent hemodynamic changes is between 2.4 and 2.8 ng/ml.
Key Words: Heart rate, Mean blood pressure, Rapid sequence intubation, Remifentanil

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