Optimal dose of remifentanil for the prevention of hemodynamic responses during induction of anesthesia with desflurane

ABSTRACT

BACKGROUND: This study was designed to determine the optimal dose of remifentanil single bolus for the prevention of cardiovascular disturbance due to both a rapid increase in desflurane concentration and stimulation by intubation. METHODS: One hundred three adult patients were enrolled in this prospective, double-blind, randomized study. Before anesthesia induction, all patients received normal saline (control) or one of the following 3 doses of remifentanil 1.0 microg/kg of remifentanil (remifentanil 1.0), 1.5 microg/kg of remifentanil (remifentanil 1.5), and 2.0 microg/kg of remifentanil (remifentanil 2.0). After induction with propofol and rocuronium, 1.3 minimal alveolar concentration of desflurane with oxygen was administered via a face mask. Heart rate (HR) and mean blood pressure (MBP) were recorded before remifentanil administration, and 1, 2, and 3 min after inhalation of desflurane, as well as 0, 1, 2, and 3 min after intubation. The proportions of patients with hemodynamics that maintained within +/- 25% of preinduction values (MBP and HR proportion) were calculated. RESULTS: MBP and HR were lower in the 3 remifentanil groups than in the control group throughout the study period. The MBP proportion was higher in remifentanil 1.0 group than in control group. The HR proportion was higher in the 3 remifentanil groups than in control group. CONCLUSIONS: A single bolus injection of remifentanil (1.0-2.0 microg/kg) may be effective in alleviating adverse hemodynamic changes induced by both desflurane inhalation and tracheal intubation. Especially, administration of remifentanil 1.0 microg/kg maintained more stable blood pressure compared to the control group throughout the study period.