Document Detail


The use of remifentanil to facilitate the insertion of the Cobra perilaryngeal airway.
MedLine Citation:
PMID:  19372329     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The use of remifentanil before propofol administration facilitates the insertion of the Laryngeal Mask Airway. We designed the present study to determine whether remifentanil would also create more suitable conditions for providing Cobra Perilaryngeal airway (CobraPLA) insertion when administered with propofol. METHODS: Both remifentanil and propofol were given as effect-site target-controlled infusions. There were four groups of 25 patients each. The propofol effect-site concentration was set at 6 microg/mL in all groups. Group R1 received a target effect-site remifentanil concentration of 1 ng/mL, Group R2 received remifentanil at 2 ng/mL, Group R3 received remifentanil at 3 ng/mL, and Group R4 received remifentanil at 4 ng/mL before the induction of anesthesia with propofol. The ease of insertion of CobraPLA was graded by the following 3-point scale: Grade 1, excellent, no response to CobraPLA insertion; Grade 2, acceptable, gagging or swallowing with insertion of CobraPLA; Grade 3, poor, unable to open mouth or biting upon insertion of CobraPLA. RESULTS: The most patients ranked as excellent for the first CobraPLA insertion (Grade 1) were found in Group R4, which was significantly higher than Groups R1 and R2 (P < 0.01), whereas no significant difference was found when compared with Group R3. The duration of apnea showed a significant dose-related increase (P < 0.01), especially between Group R2 (median 2.95 min) and R3 (median 7.9 min), but there was no significant difference between Groups R3 and R4. The incidence of hypotension in Group R4 within 1 min after insertion of CobraPLA was significantly more than for Groups R1 and R2 (P < 0.01). No significant differences could be found between the incidence of hypotension between Group R3 and the other groups. The incidence of hypertension at 1 min postinsertion was significantly more common in Groups R1 and R2 than Groups R3 and R4 (P < 0.01). CONCLUSION: An effect-site concentration of remifentanil of 2 ng/mL provides excellent conditions for insertion of the CobraPLA on the first attempt with minimal hemodynamic perturbations and a shorter duration of apnea.
Authors:
Woo Jae Jeon; Kyoung Hun Kim; Jung Kook Suh; Sang Yun Cho
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  108     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-17     Completed Date:  2009-04-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1505-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Korea.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, General*
Anesthetics, Combined / administration & dosage*,  adverse effects
Anesthetics, Intravenous / administration & dosage*,  adverse effects
Apnea / etiology,  prevention & control
Blood Pressure / drug effects
Equipment Design
Female
Heart Rate / drug effects
Humans
Infusions, Intravenous
Laryngeal Masks*
Male
Middle Aged
Piperidines / administration & dosage*,  adverse effects
Propofol / administration & dosage*,  adverse effects
Respiration, Artificial / adverse effects,  instrumentation*
Time Factors
Chemical
Reg. No./Substance:
0/Anesthetics, Combined; 0/Anesthetics, Intravenous; 0/Piperidines; 132875-61-7/remifentanil; 2078-54-8/Propofol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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