A prospective clinical trial predicting the 95% effective concentration of remifentanil for skull pin fixation using haemodynamic and surgical pleth index monitoring
Background and Aims: Inadequate antinociception during skull pin fixation can destabilise haemodynamics in patients undergoing intracranial surgery. However, the concentration of remifentanil required to achieve sufficient antinociception and maintain stable haemodynamics under surgical pleth index...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-06-01
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| Series: | Indian Journal of Anaesthesia |
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| Online Access: | https://journals.lww.com/10.4103/ija.ija_911_24 |
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| author | Ying-Tzu Chen Yueh-Ting Lai Hou-Chuan Lai Ann-Shung Lieu Meei-Shyuan Lee Zhi-Fu Wu |
| author_facet | Ying-Tzu Chen Yueh-Ting Lai Hou-Chuan Lai Ann-Shung Lieu Meei-Shyuan Lee Zhi-Fu Wu |
| author_sort | Ying-Tzu Chen |
| collection | DOAJ |
| description | Background and Aims:
Inadequate antinociception during skull pin fixation can destabilise haemodynamics in patients undergoing intracranial surgery. However, the concentration of remifentanil required to achieve sufficient antinociception and maintain stable haemodynamics under surgical pleth index (SPI) monitoring remains unestablished. We aimed to determine the 95% effective concentration (EC95) of remifentanil for skull pin fixation using haemodynamic and SPI monitoring.
Methods:
Nineteen patients undergoing intracranial surgery were enroled. Anaesthesia was administered via target-controlled infusion (TCI) of remifentanil and propofol and monitored using the SPI and bispectral index (BIS). Skull pin fixation was conducted at varying remifentanil effect-site concentrations, determined using Dixon’s up-and-down method with a 0.5-ng/mL step size while maintaining a BIS of 40–60. Severe pain was defined as SPI >80, haemodynamic change >20% from baseline, heart rate (HR) >100 bpm, or blood pressure >180/100 mmHg and classified as a failure. Success was defined as SPI ≤80 and haemodynamic stability (haemodynamic changes < 20% from baseline, HR ≤100 bpm, and arterial blood pressure ≤180/100 mmHg occurring simultaneously). Statistical tests were conducted using SPSS Statistics (Version 27.0; IBM, Armonk, NY) for Windows.
Results:
Probit analysis of seven pairs of failure-success outcomes revealed that the EC95 of remifentanil for skull pin fixation, providing adequate antinociception and haemodynamic stability, was 4.23 ng/mL.
Conclusion:
Skull pin fixation can be performed in 95% of patients without triggering noxious stimulation-induced cardiovascular responses by setting remifentanil to 4.23 ng/mL, utilising remifentanil/propofol TCI with SPI and BIS monitoring. |
| format | Article |
| id | doaj-art-2ada8adafbf64122958e76ac945705be |
| institution | OA Journals |
| issn | 0019-5049 0976-2817 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Anaesthesia |
| spelling | doaj-art-2ada8adafbf64122958e76ac945705be2025-08-20T02:02:58ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172025-06-0169659459910.4103/ija.ija_911_24A prospective clinical trial predicting the 95% effective concentration of remifentanil for skull pin fixation using haemodynamic and surgical pleth index monitoringYing-Tzu ChenYueh-Ting LaiHou-Chuan LaiAnn-Shung LieuMeei-Shyuan LeeZhi-Fu WuBackground and Aims: Inadequate antinociception during skull pin fixation can destabilise haemodynamics in patients undergoing intracranial surgery. However, the concentration of remifentanil required to achieve sufficient antinociception and maintain stable haemodynamics under surgical pleth index (SPI) monitoring remains unestablished. We aimed to determine the 95% effective concentration (EC95) of remifentanil for skull pin fixation using haemodynamic and SPI monitoring. Methods: Nineteen patients undergoing intracranial surgery were enroled. Anaesthesia was administered via target-controlled infusion (TCI) of remifentanil and propofol and monitored using the SPI and bispectral index (BIS). Skull pin fixation was conducted at varying remifentanil effect-site concentrations, determined using Dixon’s up-and-down method with a 0.5-ng/mL step size while maintaining a BIS of 40–60. Severe pain was defined as SPI >80, haemodynamic change >20% from baseline, heart rate (HR) >100 bpm, or blood pressure >180/100 mmHg and classified as a failure. Success was defined as SPI ≤80 and haemodynamic stability (haemodynamic changes < 20% from baseline, HR ≤100 bpm, and arterial blood pressure ≤180/100 mmHg occurring simultaneously). Statistical tests were conducted using SPSS Statistics (Version 27.0; IBM, Armonk, NY) for Windows. Results: Probit analysis of seven pairs of failure-success outcomes revealed that the EC95 of remifentanil for skull pin fixation, providing adequate antinociception and haemodynamic stability, was 4.23 ng/mL. Conclusion: Skull pin fixation can be performed in 95% of patients without triggering noxious stimulation-induced cardiovascular responses by setting remifentanil to 4.23 ng/mL, utilising remifentanil/propofol TCI with SPI and BIS monitoring.https://journals.lww.com/10.4103/ija.ija_911_24bispectral indexintracranial surgerynociceptionremifentanilskull pin fixationsurgical pleth index |
| spellingShingle | Ying-Tzu Chen Yueh-Ting Lai Hou-Chuan Lai Ann-Shung Lieu Meei-Shyuan Lee Zhi-Fu Wu A prospective clinical trial predicting the 95% effective concentration of remifentanil for skull pin fixation using haemodynamic and surgical pleth index monitoring Indian Journal of Anaesthesia bispectral index intracranial surgery nociception remifentanil skull pin fixation surgical pleth index |
| title | A prospective clinical trial predicting the 95% effective concentration of remifentanil for skull pin fixation using haemodynamic and surgical pleth index monitoring |
| title_full | A prospective clinical trial predicting the 95% effective concentration of remifentanil for skull pin fixation using haemodynamic and surgical pleth index monitoring |
| title_fullStr | A prospective clinical trial predicting the 95% effective concentration of remifentanil for skull pin fixation using haemodynamic and surgical pleth index monitoring |
| title_full_unstemmed | A prospective clinical trial predicting the 95% effective concentration of remifentanil for skull pin fixation using haemodynamic and surgical pleth index monitoring |
| title_short | A prospective clinical trial predicting the 95% effective concentration of remifentanil for skull pin fixation using haemodynamic and surgical pleth index monitoring |
| title_sort | prospective clinical trial predicting the 95 effective concentration of remifentanil for skull pin fixation using haemodynamic and surgical pleth index monitoring |
| topic | bispectral index intracranial surgery nociception remifentanil skull pin fixation surgical pleth index |
| url | https://journals.lww.com/10.4103/ija.ija_911_24 |
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