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.

Bispectral Index and Hemodynamic and Catecholamine Responses to Intubation during Target-Effect Site-Controlled Infusion of Propofol with Fentanyl Coadministration / 대한마취과학회지

BACKGROUND: We evaluated bispectral index (BIS) and hemodynamic and catecholamine responses to induction and intubation at different effect site concentrations during the target-effect site-controlled infusion of propofol with fentanyl coadministration. METHODS: Thirty patients scheduled for elective surgery under general anesthesia were randomly assigned to two groups. Anesthesia was induced using the target-effect site-controlled infusion of propofol at different effect site concentrations (Group I: 3.0microgram/ml, Group II: 3.5microgram/ml) following bolus injection of fentanyl (2microgram/kg). We measured BIS and systolic, diastolic, and mean arterial blood pressures, heart rate, epinephrine (E), and norepinephrine (NE) 5 min before induction, at loss of consciousness, just before intubation, immediately after intubation, and 1, 2, and 3 minutes after intubation. RESULTS: No significant differences were observed in hemodynamic or catecholamine responses to induction or intubation between the two groups. In both groups, hemodynamic changes to induction and intubation were within 30% and 20% of pre-induction levels, respectively, and catecholamine responses significantly decreased or did not change versus pre-induction levels. But in group II, the dose of propofol administered was significantly more than in group I, and BIS levels immediately before and after intubation were below 40. CONCLUSIONS: With fentanyl coadministration of 2microgram/kg, targeting 3.0microgram/ml as an effect site concentration of propofol during target-effect site-controlled infusion is better than targeting 3.5microgram/ml, because targeting the latter produced too low a BIS and too much propofol administration, although both targeted values produced similar hemodynamic and catecholamine responses.