Remifentanil Total Intravenous Anesthesia Research Articles

Anesthetic-sparing effect of dexmedetomidine during total intravenous anesthesia for children undergoing dental surgery: A randomized controlled trial.

Dexmedetomidine, an α2-adrenergic agonist, reduces propofol and remifentanil requirements when used as an adjunct to total intravenous anesthesia in adults, but studies in a pediatric population are sparse. This study investigates the magnitude of dose-sparing effects of a postinduction dexmedetomidine bolus on propofol and remifentanil requirements during pediatric surgery. In this randomized, double-blind, controlled trial, children aged 2-10 years undergoing elective dental surgery were assigned to one of four groups: placebo, 0.25 mcg/kg dexmedetomidine, 0.5 mcg/kg dexmedetomidine, and 1 mcg/kg dexmedetomidine. Maintenance with fixed-ratio propofol and remifentanil total intravenous anesthesia followed a bispectral index (BIS)-guided algorithm designed to maintain a stable depth of anesthesia. The primary outcomes were time-averaged maintenance infusion rates of propofol and remifentanil. Secondary outcomes in the postanesthetic care unit included sedation scores, pain scores, and time to discharge. Data from 67 patients were available for analysis. The median [interquartile range] propofol infusion rate was lower in the 1 mcg/kg dexmedetomidine group (180 [164-185] mcg/kg/min) versus placebo (200 [178-220] mcg/kg/min): percent change -10.0%; 95% CI -2.4 to -19.8; p = 0.013. The remifentanil infusion rate was also lower in the 1 mcg/kg dexmedetomidine group (0.089 [0.080, 0.095] mcg/kg/min) versus placebo (0.103 [0.095, 0.106] mcg/kg/min): percent change, -13.7%; 95% CI -5.47 to -21.0; p = .022. However, neither propofol nor remifentanil infusion rates were significantly different in the 0.25 or 0.5 mcg/kg dexmedetomidine groups. In the postanesthesia care unit, there were no differences in pain or sedation scores, and time to discharge was not significantly prolonged in any dexmedetomidine group. Dexmedetomidine 1 mcg/kg reduced the propofol and remifentanil requirements during maintenance of anesthesia in children when administered as a postinduction bolus. ClinicalTrials.gov: NCT03422978, date of registration 2018-02-06.

A rare case of propofol related infusion syndrome in a neurosurgical patient

Background: For the last three decades propofol has been used in anaesthesia and as a sedation technique. Several reports have warned about its use in higher doses for prolonged durations as it can have severe side effects such as propofol related infusion syndrome (PRIS), which can be fatal.1,2,3 PRIS is a rare and complex clinical condition characterized by severe metabolic acidosis, rhabdomyolysis, cardiac, liver and kidney dysfunction, and lipidemia. In its advanced stage PRIS can lead to severe refractory bradycardia and asystole.4,5 Propofol and remifentanil total intravenous anaesthesia (TIVA) is a popular anaesthesia technique. The target controlled infusion (TCI) gives predicted and controlled drug concentration and has added to the increased use of TIVA. Not much literature is available about the use of propofol and remifentanil TIVA and occurrence of PRIS. We report a case of PRIS in a neurosurgical patient with history of dyslipidemia. Case presentation: A 46-year old man weighing 68 kg, with a known case of hyperlipidemia, presented with decreased hearing on the left side, headache, and perioral numbness. Computerized tomography (CT) of the head showed left cerebropontine angle cystic lesion. His home medications were oral sodium chloride 1200 mg three times daily and pravastatin 20 mg once daily. He was electively scheduled for surgery under general anaesthesia, which lasted for seven hours. He received a TCI with propofol and remifentanil. He remained hemodynamically stable throughout the procedure.Over 7 hours the patient received a total of 3332 mg of 1% propofol, remifentanil TCI 3–4 mcg/ml, ephedrine 18 mg, mannitol 20%–250 ml, pancuronium 16 mg, vecuronium 25 mg, cefazoline 2 g, dexamethasone 16 mg, neostigmine 5 mg, glycopyrolate 1 mg, and labetalol 25 mg. He received 2 liters of crystalloid and one liter of colloid during the surgery. Intra-operative blood sugar remained around 6–7 mmol/L and his central venous pressure was maintained between 8–11 mmHg.His first arterial blood gas showed increasing lactate and metabolic acidosis after two hours of anaesthesia and it continued to rise till the end of surgery. He was extubated and shifted to the surgical intensive care unit (SICU) with a Glasgow Coma Score of 15, spontaneously breathing and with stable hemodynamics. The serum lactate continued to rise in SICU for the first 12 hours and then slowly started to decline (Figure 1). A graph of the trends of carbon dioxide and serum bicarbonate levels is shown in Figure 2. The triglycerides level reached 11.46 (Figure 3), creatine kinase 1852 U/L and myoglobin 474 ng/ml which showed decline within the next 24 hours.He remained hemodynamically stable with adequate urine output. On day one we resumed atorvastatin 20 mg, labetalol prn, bicarbonate infusion. After 24 hours, his lactate levels were normalized and acidosis resolved. The patient was discharged without any complications.Conclusion: Propofol TIVA with TCI is a common anesthesia practice. In a known dyslipidemic patient it will increase the risk for PRIS. In our patient, other risk factors for development of PRIS were higher dose, neurosurgical procedure, and extended duration of propofol infusion. The authors believe it is the first case of PRIS in a dyslipidemic patient undergoing neurosurgery with TIVA.

Effect of propofol and remifentanil on cerebral perfusion and oxygenation in pigs: a systematic review.

The objective of this review is to evaluate the existing literature with regard to the influence of propofol and remifentanil total intravenous anaesthesia (TIVA) on cerebral perfusion and oxygenation in healthy pigs. Anaesthesia has influence on cerebral haemodynamics and it is important not only in human but also in veterinary anaesthesia to preserve optimal regulation of cerebral haemodynamics. Propofol and remifentanil are widely used in neuroanaesthesia and are increasingly used in experimental animal studies. In translational models, the pig has advantages compared to small laboratory animals because of brain anatomy, metabolism, neurophysiological maturation, and cerebral haemodynamics. However, reported effects of propofol and remifentanil on cerebral perfusion and oxygenation in pigs have not been reviewed. An electronic search identified 99 articles in English. Title and abstract screening selected 29 articles for full-text evaluation of which 19 were excluded with reasons. Of the 10 peer-reviewed articles included for review, only three had propofol or remifentanil anaesthesia as the primary study objective and only two directly investigated the effect of anaesthesia on cerebral perfusion and oxygenation (CPO). The evidence evaluated in this systematic review is limited, not focused on propofol and remifentanil and possibly influenced by factors of potential importance for CPO assessment. In one study of healthy pigs, CPO measures were within normal ranges following propofol-remifentanil anaesthesia, and addition of a single remifentanil bolus did not affect regional cerebral oxygen saturation (rSO2). Even though the pool of evidence suggests that propofol and remifentanil alone or in combination have limited effects on CPO in healthy pigs, confirmative evidence is lacking.

Propofol and remifentanil total intravenous anesthesia and the preservation of spontaneous respiration for a patient with mediastinal mass

Propofol and remifentanil total intravenous anesthesia and the preservation of spontaneous respiration for a patient with mediastinal mass

Application of target-controlled infusion of propofol combined with remifentanil in the elderly patients undergoing laparoscopic surgery

Objective To compare target-controlled infusion of propofol combined with remifentanil total intravenous anesthesia and intravenous combined with inhalation anesthesia in hemodynamic changes and side effects in elderly patients with laparoseopic cholecystectomy.Methods 56 ASA Ⅰ-Ⅱ patients aged ＞60 Y undergoing elective laparoscopie cholecystectomy were randomly divided into propofol-remifentanil target controlled infusion group (observation group)(n=28)and inhalation anesthesia group(using intravenous anesthesia was maintained with isoflurane inhalation)(n=28).HR,SBP,DBP,PETCO2,initial consciousness time,extubation time,side-effects were recorded at each time points.Results The change extent of HR and blood pressure in observation group was lower than inhalation anesthesia group.The initial recovery time,recovery time of spontaneous breathing and extubation time in the observation group Was better than anesthesia group(all P＜0.05).The side-effects in observation group were significantly lower than inhalation anesthesia group(all P＜0.05).Conclusion Laparoscopic cholecystectomy in elderly patients by target-controlled infusion of propofol combined with remifentanil total intravenous anesthesia could significantly inhibit the stress response,and effectively maintain the stability of hemodynamic,and rapid postoperative recovery,fewer adverse reactions.It Was an ideal anesthesia methods in elderly patients with laparoscopic cholecystectomy. Key words: Propofol; remifentanil; Target-controlled infusion; Laparoscopic cholecystectomy

Impact of Dexmedetomidine total intravenous anaesthesia on obese patients

Objective To compare the impact on the circulation function and anesthetic recovery between the obese perioperative patients with elective modi?ed radical mastectomy received dexmedetomidine total intravenous anaesthesia and the ones received remifentanil total intravenous anaesthesia; and to explore the anti-pain effect and side-effects of the two group patients. Methods In this prospective randomized double-blind study, 56 cases ASA Ⅰ～Ⅱ and age 34 ～ 60yr morbidly obese patients who were scheduled for modi?ed radical mastectomy, were allocated into two groups averagely.Dexmedetomidine group received i.v. dexmedetomidine 1 μ g/kg as preinduction within 15 minutes, then muscular to maintain anaesthesia. Record hemodynamics changes and anaesthesia drug dose during the operation. Record the anaesthetic recovery time, and observe the postoperative adverse reaction. Results Propofol-remifentanil and propofol-dexmedetomidine got similar intraoperative hemodynamic responses;the mean arterial pressure was similar in the two groups(P＞0.05), but heart rate was higher after extubation in remifentanil group (P＜ 0.05). Propofol doses for induction and maintenance of anesthesia was lower within dexmedetomidine group. The need for earliest analgesic administration was delayed, and the incidence rate of postoperative respiratory depression, nausea, vomiting, shivering were lower in dexmedetomidine group (P＜0.05); but the recovery time was longer(P＜0.05). Bradycardia was similar between two groups (P＞ 0.05). Conclusion Dexmedetomidine total intravenous anesthesia provide stable hemodynamics for the morbidly obese patients with elective modi?ed radical mastectomy; and can decrease propofol consumption and undesirable side-effects, delay postoperative analgesics requirement, but it fail to facilitate anesthetic recovery. Key words: Dexmedetomidine; Anesthsia; Obesity

Comparison of sevoflurane volatile induction/maintenance anaesthesia and propofol–remifentanil total intravenous anaesthesia for rigid bronchoscopy under spontaneous breathing for tracheal/bronchial foreign body removal in children

Foreign body aspiration is a life-threatening condition, with children under 3 years of age most at risk. This study was designed to compare the clinical characteristics of sevoflurane volatile induction/maintenance anaesthesia (VIMA) and propofol-remifentanil total intravenous anaesthesia (TIVA) for children undergoing rigid bronchoscopy under spontaneous breathing for tracheal/bronchial foreign body removal. Sixty-four children undergoing rigid bronchoscopy were allocated randomly to receive sevoflurane (Group VIMA; n = 32) or propofol-remifentanil (Group TIVA, n = 32) between 2007 and 2009. Respiratory rate, heart rate and mean blood pressure were compared at the time points including baseline level (T 0); laryngoscopy (T lary); insertion of rigid bronchoscope (T bron); 5, 10 and 20 min during procedure (T 5 min, T 10 min, T 20 min); the end of procedure (Tend) and discharge (T dis). Induction time, emergence time, intubating condition scores and the incidence of adverse events were compared. Time for loss of consciousness (Group VIMA 95.6 ± 15.2 s vs. Group TIVA 146.2 ± 26.9 s, P < 0.05), time of Bispectral Index value decreased to 40 (Group VIMA 115.3 ± 16.5 s vs. Group TIVA 160.4 ± 25.8 s, P < 0.05) and emergence time (Group VIMA 10.5 ± 2.6 min vs. Group TIVA 16.9 ± 3.1 min, P < 0.05) in Group VIMA were significantly shorter than those in Group TIVA. Intubating condition scores between the two groups were comparable (8.1 ± 0.9 in Group VIMA vs. 8.1 ± 1.0 in Group TIVA). The incidence rates of breath holding (Group VIMA 6.25% vs. Group TIVA 31.25%, P < 0.05) and desaturation (Group VIMA 15.63% vs. Group TIVA 37.50%, P < 0.05) in Group VIMA were significantly lower than those in Group TIVA. Heart rate, mean blood pressure and respiratory rate were significantly higher in Group VIMA than in Group TIVA. Compared with propofol-remifentanil TIVA, sevoflurane VIMA provides more stable haemodynamics and respiration, faster induction and recovery and higher incidence of excitement in paediatric patients undergoing tracheal/bronchial foreign body removal under spontaneous breathing.

Susceptibility of Transcranial Electric Motor-evoked Potentials to Varying Targeted Blood Levels of Dexmedetomidine during Spine Surgery

Dexmedetomidine has been increasingly used as an adjunct to opioid-propofol total intravenous anesthesia (TIVA). The authors tested the hypothesis and found that clinically relevant blood levels of dexmedetomidine do not produce significant attenuation of the amplitude of transcranial electric motor-evoked potentials either independently or by interaction with propofol in a dose-dependent manner. The authors planned to recruit 72 patients with idiopathic scoliosis who had posterior spine fusion surgery during propofol and remifentanil TIVA with dexmedetomidine as an adjunct. However, the authors terminated the study after enrolling 44 patients because of change in surgical technique. Before administering dexmedetomidine, baseline transcranial electric motor-evoked potentials were acquired during TIVA with remifentanil and propofol. Patients were randomized to varying targeted blood levels of dexmedetomidine (0.4, 0.6, and 0.8 ng/ml) and propofol (2.5, 3.75, and 5 microg/ml) using a factorial design. The primary outcome variable was amplitude of transcranial electric motor-evoked potential. The secondary outcome was amplitude of cortical somatosensory-evoked potentials. Of the 44 recruited patients, 40 completed the study, and their data were analyzed. The administration of dexmedetomidine in increasing doses as an adjunct to propofol-based TIVA caused a clinically and statistically significant attenuation of amplitudes of transcranial electric motor-evoked potentials. The authors conclude that under the stimulation conditions used, dexmedetomidine as an anesthetic adjunct to propofol-based TIVA at clinically relevant target plasma concentrations (0.6-0.8 ng/ml) can significantly attenuate the amplitude of transcranial electric motor-evoked potentials.

Compare Propofol combined with Remifentanil total intravenous anaesthesia with Propofol combined with isoflurane infusion-intravenous undergoing laparoscopic operation

Objective To evaluation the effects of immune status from Compare propofol combined with remifentanil total intravenous anaesthesia undergoing laparoscopic operation. Methods 100 ASA Ⅰ～Ⅱ patients undergoing cysticolithby laparoscopic were randomly allocated into 2 groups ( n = 50 ); Group A: propofol combined with remifentanil total intravenous anaesthesia; Group B: propofol combined with isoflurane infusion-intravenous anaesthesia. MAP、HR and Blood Glue of before anaesthesia、pneumoperitoneum immediately、20 min after pneumoperitoneum and postoperative immediately for tow groups patients were recorded. Results MAP、HR at pneumoperitoneum immediately, group A was lowest than group B ( P ＜ 0.01 ); Blood Glue at 20 min after pneumoperitoneum and postoperative immediately, group A was lower than group B ( P ＜ 0.05 ). Conclusion Propofol combined with remifentanil total intravenous anaesthesia can more effective to prevent the effects of immune status from CO2 pneumoperitoneum than propofol combined with isoflure infusion-intravenous. Key words: Laparoscopic operation; Remifentanil; Propofol; Total intravenous anaesthesia; Isoflurane infusion-intravenous anaesthesia

No Supplemental Muscle Relaxants Are Required During Propofol and Remifentanil Total Intravenous Anesthesia for Laparoscopic Pelvic Surgery

No administration of supplemental muscle relaxants may be beneficial to the recovery of the ambulatory laparoscopic surgery. For this study, we compared the cardiorespiratory factors during propofol and remifentanil anesthesia for laparoscopic pelvic surgery (LPS) with or without supplemental muscle relaxants. In total, 56 healthy female patients scheduled to undergo laparoscopic pelvic surgeries were randomly assigned to two groups (A and B). Anesthesia was induced with lidocaine 30 mg, propofol target organ concentration 5.0 microg/mL, remifentanil 3.0 ng/mL, and rocuronium 0.6 mg/kg intravenously (i.v.). After tracheal intubation, anesthesia was maintained with 2.0-5.0 microg/mL of propofol and 1-4 ng/mL of remifentanil i.v. All the patients' lungs were mechanically ventilated in both groups and intermittent bolus doses of rocuronium (0.15 mg/kg i.v.) were administered in group A-however, not in group B. Heart rate (HR) and systolic arterial pressure (SAP), diastolic arterial pressure (DAP), end-tidal carbon-dioxide concentration (EtCO(2)), peak inspiratory pressure (PIP), expired minute ventilation (MV), intra-abdominal pressure (IAP), and temperature were measured during the pneumoperitoneum. There were no group differences in HR, SAP, DAP, EtCO(2), PIP, IAP, MV, PaO(2), PaCO(2), and temperature between groups A and B. No supplemental muscle relaxants are required during propofol and remifentanil total i.v. anesthesia for LPS.

No supplemental neuromuscular blockers are required during propofol and remifentanil total intravenous anesthesia for laparoscopic pelvic surgery

No supplemental neuromuscular blockers are required during propofol and remifentanil total intravenous anesthesia for laparoscopic pelvic surgery

Caesarean section using total intravenous anaesthesia in a patient with Ebstein’s anomaly complicated by supraventricular tachycardia

Ebstein's anomaly is a rare congenital cardiac defect associated with both displacement and incompetence of the tricuspid valve. The condition is commonly complicated by supraventricular tachycardias. We describe the management of a patient with this condition undergoing caesarean section. Propofol and remifentanil total intravenous anaesthesia resulted in haemodynamic stability and delivery of a healthy baby who breathed spontaneously after two minutes.

Propofol and remifentanil total intravenous anesthesia for a patient with Huntington disease

Huntington disease presents many challenges for the anesthetist. Of primary importance is that these patients are at increased risk of pulmonary aspiration. The use of short-acting anesthetic drugs should, therefore, be advantageous in promoting the rapid return of protective airway reflexes. We report the first documented use, to date, of propofol and remifentanil total intravenous anesthesia in a patient with Huntington disease and demonstrate its efficacy and safety.