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A Multicenter Evaluation of Total Intravenous Anesthesia with Remifentanil and Propofol for Elective Inpatient Surgery

1996; Lippincott Williams & Wilkins; Volume: 83; Issue: 2 Linguagem: Inglês

10.1097/00000539-199608000-00014

1526-7598

Charles W. Hogue, Andrew Bowdle, Colleen E. O’Leary, Deryck Duncalf, Rafael Miguel, Melvin Pitts, James B. Streisand, George Kirvassilis, Brenda D. Jamerson, Sally McNeal, Randal L. Batenhorst,

Anesthesia and Neurotoxicity Research

Remifentanil is a mu-opioid receptor agonist with a context sensitive half-time of 3 min and an elimination half-life <or=to10 min. This study sought to evaluate the efficacy of remifentanil and propofol total intravenous anesthesia (TIVA) in 161 patients undergoing inpatient surgery. Remifentanil 1 micro gram/kg was given intravenously (IV) followed by one of two randomized infusion rates: small dose (0.5 micro gram centered dot kg-1 centered dot min-1) or large dose (1 micro gram centered dot kg-1 centered dot min-1). Propofol (0.5-1.0 mg/kg IV bolus and 75 micro gram centered dot kg-1 centered dot min-1 infusion) and vecuronium were also given. Remifentanil infusions were decreased by 50% after tracheal intubation. End points included responses (hypertension, tachycardia, and somatic responses) to tracheal intubation and surgery. More patients in the small-dose than in the large-dose group responded to tracheal intubation with hypertension and/or tachycardia (25% vs 6%; P = 0.003) but there were no other differences between groups in intraoperative responses. Recovery from anesthesia was within 3-7 min in both groups. The most frequent adverse events were hypotension (systolic blood pressure [BP] < 80 mm Hg or mean BP < 60 mm Hg) during anesthesia induction (10% small-dose versus 15% large-dose group; P = not significant [NS]) and hypotension (27% small-dose versus 30% large-dose group; P = NS), and bradycardia (7% small-dose versus 19% large-dose group; P = NS) during maintenance. In conclusion, when combined with propofol 75 micro gram centered dot kg-1 centered dot min-1, remifentanil 1 micro gram/kg IV as a bolus followed by an infusion of 1.0 micro gram centered dot kg-1 centered dot min-1 effectively controls responses to tracheal intubation. After tracheal intubation, remifentanil 0.25-4.0 micro gram centered dot kg-1 centered dot min-1 effectively controlled intraoperative responses while allowing for rapid emergence from anesthesia. (Anesth Analg 1996;83:279-85)