Heart Rate Variability during Propofol-Remifentanil TCI Induction in Diabetic Patients / 대한마취과학회지

BACKGROUND: The aim of this study was to compare heart rate variability (HRV) changes between diabetics and non-diabetics throughout induction with maintaining BIS 40-60 by propofol-remifentanil target controlled infusion. METHODS: Non-diabetic patients (n = 12) and non-insulin dependent diabetes mellitus (NIDDM) patients (n=12) were recruited. Anesthesia was induced by target controlled infusion of propofol and remifentanil. Target effect-site concentration of propofol was adjusted to maintain bispectral index (BIS) 40-60, and target effect-site concentration of remifentanil was adjusted to maintain blood pressure (BP) within 20% of baseline value. The HRV was recorded at resting, after glycopyrrolate injection, during BIS 40-60, and after intubation. Log-transformed power spectrum (ms2) of TP (total power, < or = 0.4 Hz), LF (low frequency, 0.04-0.15 Hz), HF (high frequency, 0.15-0.4 Hz), LFnorm (normalized LF, LF/[LF + HF]), HFnorm (normalized HF, HF/[LF + HF]), and LF/HF ratio were compared. RESULTS: Initial LnTP, LnLF, and LnHF was significantly lower in diabetics (P < 0.05). During BIS 40-60, LnTP, LnLF, and LnHF in non-diabetics decreased significantly (P < 0.05). Immediately after intubation, LnLF, LnHF in non-diabetics, and LnHF in diabetics decreased significantly (P < 0.05). LF/HF ratio showed no significant change throughout induction. Systolic, diastolic BP, mean arterial pressure, and heart rate have no significant differences between the groups. CONCLUSIONS: This study suggests that hemodynamic variables and balance of autonomic nervous system measured by HRV can not be altered during induction, by adjusting effect site concentration of propofol and remifentanil in accordance with BIS and BP in diabetic patients.

Hemodynamic Changes between Different Remifentanil Administration Methods during Induction in the Elderly / 대한마취과학회지

BACKGOUND: The elderly have increased sensitivity to opioids and anesthetics. The hemodynamic effects of propofol- remifentanil during induction are not known in the elderly. This study was designed to compare two different remifentanil administration methods during propofol-remifentanil induction and tracheal intubation in the elderly. METHODS: Forty patients, ages over 65 years were enrolled. Anesthesia was induced with propofol 1 mg/kg and remifentanil. In Group T (TCI : target controlled infusion), remifentanil 3.5 ng/ml were infused until laryngoscopy and tracheal intubation. In Group R (rapid infusion), infusion were stopped when effect-site concentration reaches 5.0 ng/ml. Mean arterial pressure (MAP) and heart rate (HR) were recorded before induction (baseline), after remifentanil reaches its target effect-site concentration, after administration of propofol, 1 minute before intubation, 1 minute after intubation and 3 minute after intubation. RESULTS: In both groups, MAP decreased significantly after induction and then increases significantly after intubation (P < 0.05). In Group R, MAP decreased earlier and was significantly lower than that of Group T (P < 0.05) before intubation. HR shows no significant changes between groups. CONCLUSIONS: In these two methods, there are no severe hemodynamic compromise during induction and tracheal intubation in the elderly. However, lesser degree of hypotension occurs in Group T. So we conclude that TCI method can provide better hemodynamic stability than rapid infusion method.