ABSTRACT
BACKGROUND: The purpose of this study is to determine the optimal dose of remifentanil and propofol for minimizing the cardiovascular changes to tracheal intubation during total intravenous anesthesia (TIVA) using propofol target controlled infusion (TCI). METHODS: One hundred thirty five patients, aged 20-60 years, were randomly divided into three groups. Anesthesia was induced with remifentanil, propofol and rocuronium 1 mg/kg for intubation. Group I received remifentanil 0.1microgram/kg/min and a propofol target concentration 4microgram/ml. Group II received remifentanil 0.2microgram/kg/min and propofol 4microgram/ml. Group III received remifentanil 0.2microgram/kg/min and propofol 3microgram/ml. Remifentanil was infused continuously, and 2 minutes after remifentanil infusion, propofol was infused continuously. Mean arterial blood pressure (MAP) and heart rate (HR) were measured at pre-induction, 1 minute after remifentanil infusion, before propofol TCI, immediately before and after intubation and 1, 2, 3 minutes after intubation, respectively. RESULTS: Compared with pre-induction values, MAP at immediately after intubation was significantly increased in group I, but decreased in group II, with no change in group III. The HR immediately after intubation was significantly increased after intubation in all groups compared to the pre-induction values, but the rate of increase of HR in groups II, III were significantly lower than those of group I (p < 0.05). Hypotension was observed in 6 patients in group II and 3 in group III. CONCLUSIONS: Remifentanil 0.2microgram/kg/min and the propofol target concentration 3microgram/ml are optimal doses for minimizing cardiovascular changes and side effects to tracheal intubation during TIVA.
Subject(s)
Aged , Humans , Androstanols , Anesthesia , Anesthesia, Intravenous , Arterial Pressure , Heart Rate , Hypotension , Intubation , Piperidines , PropofolABSTRACT
BACKGROUND: There is a greater incidence of complications such as desaturation, laryngospasm, airway obstruction and vomiting during tracheal extubation than intubation. We survey to ascertain current tracheal extubation practice and to estimate the incidence of problems associated with extubation and suggest the recommendation about extubation practice. METHODS: We sent an anonymous questionnaire to resident and staffs of anesthesiology departments in five different area. These anesthesiologists were asked to complete and return anonymously in the stamped, addressed envelope provided. We received 130 replies from 134 questionnaires (97%). RESULTS: We found that 38% of respondents use awake extubation and only 1% use it for deep extubation. Eighty-two percent would use reversal agents at extubation. More than 75% usually extubated at the end of inspiration. The administration of 100% oxygen before extubation was 'always' used in every case by 81% of anesthesiologists. Many respondents are extubating elective, emergency surgery, and obese patients in the supine position regardless of patients situation and not following the traditional practice of extubating in the head-down and left lateral position. Every respondent had experienced average 4.1 extubation complications during last 3 months. The incidences of postoperative complications such as excessive coughing (15.3%), irritability (13.8%), desaturation (9.9%), airway obstruction (8.7%) were relatively high in our survey. CONCLUSIONS: We should need to discuss and establish recommendation how they are trained in extubation on the basis of more surveys and reported experiences.