Predicted EC₅₀ and EC₉₅ of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia

• Published in: Yonsei medical journal Vol. 56; no. 4; pp. 1128 - 1133
• Main Authors: Yoo, Ji Young, Kwak, Hyun Jeong, Lee, Kyung Cheon, Kim, Go Wun, Kim, Jong Yeop
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.07.2015; 연세대학교의과대학
• Subjects: Adolescent; Adult; Analgesics, Opioid - administration & dosage; Anesthetics, Inhalation - administration & dosage; Cough - prevention & control; Device Removal; Dose-Response Relationship, Drug; Female; Gynecologic Surgical Procedures; Humans; Laryngeal Masks; Male; Middle Aged; Original; Orthopedic Procedures; Piperidines - administration & dosage; Propofol - administration & dosage; Treatment Outcome; Young Adult; 의학일반; effect-site concentration; Laryngeal mask airway; remifentanil; target-controlled infusion; general anesthesia; device removal
• ISSN: 0513-5796; 1976-2437
• DOI: 10.3349/ymj.2015.56.4.1128

The purpose of this study was to determine the effect-site concentration (Ce) of remifentanil in 50% of patients (EC₅₀) and 95% of patients (EC₉₅) for smooth laryngeal mask airway (LMA) removal in adults under propofol and remifentanil anesthesia. Twenty-five patients of ASA physical status I-II and ages 18-60 years who were to undergo minor gynecological or orthopedic surgery were assessed in this study. Anesthesia was induced and maintained with propofol and remifentanil target-controlled infusion (TCI). Remifentanil was maintained at a predetermined Ce during the emergence period. The modified Dixon's up-and-down method was used to determine the remifentanil concentration, starting from 1.0 ng/mL (step size of 0.2 ng/mL). Successful removal of the LMA was regarded as absence of coughing/gagging, clenched teeth, gross purposeful movements, breath holding, laryngospasm, or desaturation to SpO₂<90%. The mean±SD Ce of remifentanil for smooth LMA removal after propofol anesthesia was 0.83±0.16 ng/mL. Using isotonic regression with a bootstrapping approach, the estimated EC₅₀ and EC₉₅ of remifentanil Ce were 0.91 ng/mL [95% confidence interval (CI), 0.77-1.07 ng/mL] and 1.35 ng/mL (95% CI, 1.16-1.38 ng/mL), respectively. Our results showed that remifentanil TCI at an established Ce is a reliable technique for achieving safe and smooth emergence without coughing, laryngospasm, or other airway reflexes.