Remifentanil in combination with propofol for spontaneous ventilation anaesthesia

• Published in: British journal of anaesthesia : BJA Vol. 80; no. 4; pp. 509 - 511
• Main Authors: Peacock, J E, Luntley, J B, O'Connor, B, Reilly, C S, Ogg, T W, Watson, B J, Shaikh, S
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.04.1998; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Adolescent; Adult; Aged; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Anesthetics, Intravenous; Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Interactions; Female; Humans; Male; Medical sciences; Middle Aged; Neuropharmacology; Pharmacology. Drug treatments; Piperidines - administration & dosage; Piperidines - adverse effects; Propofol; Remifentanil; Respiration - drug effects; Respiratory Insufficiency - chemically induced; Human; Surgical incision; Intravenous administration; General anesthetic; General anesthesia; Complication; Spontaneous ventilation; Respiratory depression; Propofol; Narcotic analgesic; Remifentanil; Dose activity relation
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/80.4.509

We have investigated the effect of four doses of remifentanil on the incidence of respiratory depression and somatic response at incision. Remifentanil was administered as a loading dose of 0.125, 0.25, 0.375 or 0.5 microgram kg-1 and at a maintenance infusion rate of 0.025, 0.05, 0.075 or 0.1 microgram kg-1 min-1, respectively, with an infusion of propofol 6 mg kg-1 h-1. Responses occurred in 88% of patients with remifentanil 0.025 microgram kg-1 min-1 compared with 30-40% in the other groups. Respiratory depression after incision increased from 6% with remifentanil 0.025 microgram kg-1 min-1 to 73% with 0.1 microgram kg-1 min-1. Increases in propofol infusion rate to 7.2-8.4 mg kg-1 h-1 produced adequate maintenance of anaesthesia. Reductions in remifentanil doses to 0.025-0.05 microgram kg-1 min-1 resulted in adequate respiration at the end of surgery in 88% of patients. Maintenance infusions of the two drugs for spontaneous ventilation are likely to be in these ranges. However, the ideal loading doses and infusion rates for induction remain to be established.