Propofol Reduces Perioperative Remifentanil Requirements in a Synergistic Manner

Leiden University, Leyden, South Holland, Netherlands
Anesthesiology (Impact Factor: 5.88). 09/2003; 99(2):347-59. DOI: 10.1097/00000542-200308000-00016
Source: PubMed


Remifentanil is often combined with propofol for induction and maintenance of total intravenous anesthesia. The authors studied the effect of propofol on remifentanil requirements for suppression of responses to clinically relevant stimuli and evaluated this in relation to previously published data on propofol and alfentanil.
With ethics committee approval and informed consent, 30 unpremedicated female patients with American Society of Anesthesiologists physical status class I or II, aged 18-65 yr, scheduled to undergo lower abdominal surgery, were randomly assigned to receive a target-controlled infusion of propofol with constant target concentrations of 2, 4, or 6 microg/ml. The target concentration of remifentanil was changed in response to signs of inadequate anesthesia. Arterial blood samples for the determination of remifentanil and propofol concentrations were collected after blood-effect site equilibration. The presence or absence of responses to various perioperative stimuli were related to the propofol and remifentanil concentrations by response surface modeling or logistic regression, followed by regression analysis. Both additive and nonadditive interaction models were explored.
With blood propofol concentrations increasing from 2 to 7.3 microg/ml, the C(50) of remifentanil decreased from 3.8 ng/ml to 0 ng/ml for laryngoscopy, from 4.4 ng/ml to 1.2 ng/ml for intubation, and from 6.3 ng/ml to 0.4 ng/ml for intraabdominal surgery. With blood remifentanil concentrations increasing from 0 to 7 ng/ml, the C(50) of propofol for the return to consciousness decreased from 3.5 microg/ml to 0.6 microg/ml.
Propofol reduces remifentanil requirements for suppression of responses to laryngoscopy, intubation, and intraabdominal surgical stimulation in a synergistic manner. In addition, remifentanil decreases propofol concentrations associated with the return of consciousness in a synergistic manner.

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Available from: Jaap Vuyk, Oct 05, 2015
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    • "Propofol and remifentanil are commonly co-administered in intravenous anesthesia and have shown a synergistic effect [1,2]. However, reports on hypnotic interaction between propofol and remifentanil measured by bispectral index (BIS) have been a few and contradictory [3-7]. "
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    ABSTRACT: Propofol and remifentanil are usually co-administered and have shown synergistic effect for anesthesia. However, the synergistic effect of the two drugs on hypnosis measured by bispectral index (BIS) was controversial in previous studies. The aim of this study was to identify the interaction of propofol and remifentanil on BIS and the optimal dose combinations for hypnosis under 66% N(2)O during surgery. Patients (age 55-75 and American Society of Anesthesiologists [ASA] 1-2) undergoing gastrectomy were enrolled in this study. Propofol and remifentanil were co-administered incrementally at 1 : 1 potent ratio (the P1R1 group), at 1 : 2 potent ratio (the P1R2 group), or at 2 : 1 potent ratio (the P2R1 group) using effect site target-controlled infusion and BIS was measured. 66% N(2)O was concomitantly administered to all groups. The dose-effect curves, the 90% effective dose (EC(90)) for adequate hypnosis (BIS 40), isobolograms and combination index were obtained by Calcusyn program (Biosoft) to reveal the interaction of propofol and remifentanil. The P2R1 group showed synergistic action on BIS. However, the other groups needed larger amount of each drug than the doses of additive action. The EC(90) of the P2R1 group was propofol, 3.34 µg/ml and remifentanil, 2.41 ng/ml under 66% of N(2)O. Propofol dominant co-administration is needed for dose reduction in BIS guided hypnosis.
    Korean journal of anesthesiology 12/2010; 59(6):371-6. DOI:10.4097/kjae.2010.59.6.371
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    ABSTRACT: Background: The optimal dose of propofol and remifentanil induction to minimize the cardiovascular response associ-ated with tracheal intubation may exist. We investigated the cardiovascular response associated with tracheal intubation when various continuous induction doses of remifentanil in combination with propofol were used. Methods: Seventy-five patients were randomly allocated into 1 of 3 groups: the R-0.4 P-1 group (remifentanil 0.4 μg/kg/min and propofol 1 mg/kg); the R-0.5 P-1 group (remifentanil 0.5 μg/kg/min and propofol 1 mg/kg); and the R-0.4 P-2 group (remifen-tanil 0.4 μg/kg/min and propofol 2 mg/kg). One minute after remifentanil infusion commenced, a bolus of propofol was injected. Rocuronium 1 mg/kg was administered 1 min after propofol injection following loss of consciousness. Con-trolled ventilation was then performed for 2 min, and the trachea was intubated 4 min after the start of the remifentanil infusion. The infusion rate of remifentanil was decreased to 0.1 μg/kg/min after intubation. Blood pressure (BP) and heart rate (HR) were measured during this period until 5 min after tracheal intubation. Results: The changes in BP re-sponse due to tracheal intubation in the R-0.4 P-1 group were greater than those in the other 2 groups, whereas the HR responses to tracheal intubation were similar among the 3 groups. Conclusion: The combination of remifentanil 0.4 μg/kg/min and propofol 1 mg/kg led to an exaggerated cardiovascular response to tracheal intubation compared with the other combination groups.
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    ABSTRACT: Objective: To demonstrate the optimal dose of remifentanyl between 5, 7 and 10 ng/mL during laryngoscopy in ASA I and ASA II patients. To asses the hemodynamic response that occurs during laryngoscopy and intubation when using a remifentanyl dose of 5 to 10 ng/mL. To determine the optimal conditions for endotracheal intubation with the administration of a remifentanyl dose of 5 to 10 ng/mL by the Helbo Hansen's scale. Materials and methods: 51 patients being under general anesthesia for elective ASA I, and ASA II surgeries, rang-ing between 18 and 65 years old, randomly divided into 3 groups were included in this study; Remifentanyl dosages of 5 ng/mL, 7 ng/mL and 10 ng/mL; the following measurements were performed in preoperative, at surgery admis-sion, 1, 2 and 5 minutes from the intubation of the variables: blood pressure, heart rate, oxygen saturation and bispectral index. The patients were medicat-ed with midazolam, induced with remifentanyl at the established doses accord-ing to the group they belonged to (1, 1.4 and 2 µg/kg), cisatracurio (150 µg/kg) and propofol (2, 1.5 and 1 mg/kg) respectively. Results: There was a signifi-cant difference (p < 0.05) in heart rate and blood pressure during the first minute at the laryngoscopy and in the group of remifentanyl at doses of 7 and 10 ng/mL. In addition to this, the conditions for the intubation, measured through the Helbo-Hansen's scale, from the remifentanyl Group at 10 ng/mL were more favorable than in the other groups. Conclusion: The study concludes that a remifentanyl dose of 10 ng/mL in the therapeutic window, combined with propo-fol at a dose of 1 mg/kg, provides excellent intubation conditions and increased hemodynamic stability during laryngoscopy and endotracheal intubation.
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