The effect-site concentration of remifentanil blunting endotracheal intubation responses in elderly patients during anesthesia induction with etomidate: a dose-exploration study
Abstract Purpose Laryngoscopy and endotracheal intubation are known to increase activity of the sympathetic nervous system, and are usually associated with perioperative hypertension, cardiac arrhythmia, and tachycardia. The aim of this study was to determine the effect-site concentrations of remife...
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BMC
2025-02-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-024-02844-8 |
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| author | Zhimin Hao Zhencong Jiang Jiexiong Li Tao Luo |
| author_facet | Zhimin Hao Zhencong Jiang Jiexiong Li Tao Luo |
| author_sort | Zhimin Hao |
| collection | DOAJ |
| description | Abstract Purpose Laryngoscopy and endotracheal intubation are known to increase activity of the sympathetic nervous system, and are usually associated with perioperative hypertension, cardiac arrhythmia, and tachycardia. The aim of this study was to determine the effect-site concentrations of remifentanil to inhibit the tracheal intubation response during etomidate anesthesia in elderly patients. Methods American Society of Anesthesiologists physical status I-III patients aged 65 or older and scheduled for general anesthesia for elective surgery were enrolled in the study. Anesthesia induction was applied with etomidate 0.3 mg/kg, rocuronium 0.6 mg/kg, and target controlled infusion of remifentanil under the Minto pharmacokinetic model. Invasive continuous arterial blood pressure monitoring was used throughout the operation. A positive response was defined if the maximal mean arterial pressure (MAP) or heart rate (HR) within 3 min after tracheal intubation was 20% higher than the baseline value. The Dixon sequential method was used for the test, and the initial effect-site concentrations of remifentanil was 6 ng/ml. The EC50 and EC95 for the suppression of endotracheal intubation response by remifentanil were calculated by the probit method. Results The EC50 for inhibiting tracheal intubation response by remifentanil in elderly patients was 6.53 ng/ml (95% CI:6.01–7.05 ng/ml) and EC95 was 8.05 ng/ml (95% CI:7.32–8.78 ng/ml) when combined with etomidate anesthesia. The changes of MAP, HR and BIS in positive group were significantly higher than those of negative group (P < 0.05). There were no episodes of hypoxemia, muscular tremor, chest wall rigidity or choking cough in both groups. Conclusions Target controlled infusion of remifentanil in combination with etomidate is effective preventing hemodynamic instability in elderly patients during the anesthesia induction and endotracheal intubation. Clinical trial registration This article was registered at Chinese Clinical Trial Registry ( www.chictr.org.cn registration number: ChiCTR2300076261, date of registration: 28/09/2023). |
| format | Article |
| id | doaj-art-4c9d8fe8320040c1a6341b9d6efe03da |
| institution | DOAJ |
| issn | 1471-2253 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
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| series | BMC Anesthesiology |
| spelling | doaj-art-4c9d8fe8320040c1a6341b9d6efe03da2025-08-20T02:48:16ZengBMCBMC Anesthesiology1471-22532025-02-0125111010.1186/s12871-024-02844-8The effect-site concentration of remifentanil blunting endotracheal intubation responses in elderly patients during anesthesia induction with etomidate: a dose-exploration studyZhimin Hao0Zhencong Jiang1Jiexiong Li2Tao Luo3Department of Anesthesiology, Peking University Shenzhen HospitalDepartment of Anesthesiology, Peking University Shenzhen HospitalDepartment of Anesthesiology, Peking University Shenzhen HospitalDepartment of Anesthesiology, Peking University Shenzhen HospitalAbstract Purpose Laryngoscopy and endotracheal intubation are known to increase activity of the sympathetic nervous system, and are usually associated with perioperative hypertension, cardiac arrhythmia, and tachycardia. The aim of this study was to determine the effect-site concentrations of remifentanil to inhibit the tracheal intubation response during etomidate anesthesia in elderly patients. Methods American Society of Anesthesiologists physical status I-III patients aged 65 or older and scheduled for general anesthesia for elective surgery were enrolled in the study. Anesthesia induction was applied with etomidate 0.3 mg/kg, rocuronium 0.6 mg/kg, and target controlled infusion of remifentanil under the Minto pharmacokinetic model. Invasive continuous arterial blood pressure monitoring was used throughout the operation. A positive response was defined if the maximal mean arterial pressure (MAP) or heart rate (HR) within 3 min after tracheal intubation was 20% higher than the baseline value. The Dixon sequential method was used for the test, and the initial effect-site concentrations of remifentanil was 6 ng/ml. The EC50 and EC95 for the suppression of endotracheal intubation response by remifentanil were calculated by the probit method. Results The EC50 for inhibiting tracheal intubation response by remifentanil in elderly patients was 6.53 ng/ml (95% CI:6.01–7.05 ng/ml) and EC95 was 8.05 ng/ml (95% CI:7.32–8.78 ng/ml) when combined with etomidate anesthesia. The changes of MAP, HR and BIS in positive group were significantly higher than those of negative group (P < 0.05). There were no episodes of hypoxemia, muscular tremor, chest wall rigidity or choking cough in both groups. Conclusions Target controlled infusion of remifentanil in combination with etomidate is effective preventing hemodynamic instability in elderly patients during the anesthesia induction and endotracheal intubation. Clinical trial registration This article was registered at Chinese Clinical Trial Registry ( www.chictr.org.cn registration number: ChiCTR2300076261, date of registration: 28/09/2023).https://doi.org/10.1186/s12871-024-02844-8RemifentanilEtomidateEndotracheal intubationElderly patientsHemodynamics response |
| spellingShingle | Zhimin Hao Zhencong Jiang Jiexiong Li Tao Luo The effect-site concentration of remifentanil blunting endotracheal intubation responses in elderly patients during anesthesia induction with etomidate: a dose-exploration study BMC Anesthesiology Remifentanil Etomidate Endotracheal intubation Elderly patients Hemodynamics response |
| title | The effect-site concentration of remifentanil blunting endotracheal intubation responses in elderly patients during anesthesia induction with etomidate: a dose-exploration study |
| title_full | The effect-site concentration of remifentanil blunting endotracheal intubation responses in elderly patients during anesthesia induction with etomidate: a dose-exploration study |
| title_fullStr | The effect-site concentration of remifentanil blunting endotracheal intubation responses in elderly patients during anesthesia induction with etomidate: a dose-exploration study |
| title_full_unstemmed | The effect-site concentration of remifentanil blunting endotracheal intubation responses in elderly patients during anesthesia induction with etomidate: a dose-exploration study |
| title_short | The effect-site concentration of remifentanil blunting endotracheal intubation responses in elderly patients during anesthesia induction with etomidate: a dose-exploration study |
| title_sort | effect site concentration of remifentanil blunting endotracheal intubation responses in elderly patients during anesthesia induction with etomidate a dose exploration study |
| topic | Remifentanil Etomidate Endotracheal intubation Elderly patients Hemodynamics response |
| url | https://doi.org/10.1186/s12871-024-02844-8 |
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