The EC90 of remifentanil for blunting cardiovascular responses to head fixation for neurosurgery under total intravenous anesthesia with propofol and remifentanil based on bispectral index monitoring: estimation with the biased coin up-and-down sequential method
Abstract Background Head fixation can induce hemodynamic instability. Remifentanil is commonly used with propofol for total intravenous anesthesia (TIVA) during neurosurgery. This study investigated the 90% effective concentration (EC90) of remifentanil for blunting of cardiovascular responses to he...
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BMC
2017-10-01
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| Series: | BMC Anesthesiology |
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| Online Access: | http://link.springer.com/article/10.1186/s12871-017-0426-z |
| _version_ | 1818458013659299840 |
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| author | Jung-Man Lee Jae-Hyon Bahk Young-Jin Lim Jiwon Lee Leerang Lim |
| author_facet | Jung-Man Lee Jae-Hyon Bahk Young-Jin Lim Jiwon Lee Leerang Lim |
| author_sort | Jung-Man Lee |
| collection | DOAJ |
| description | Abstract Background Head fixation can induce hemodynamic instability. Remifentanil is commonly used with propofol for total intravenous anesthesia (TIVA) during neurosurgery. This study investigated the 90% effective concentration (EC90) of remifentanil for blunting of cardiovascular responses to head fixation during neurosurgery via bispectral index (BIS) monitoring. Methods Fifty patients undergoing neurosurgery requiring head fixation were enrolled. This study was performed using the biased coin up-and-down design sequential method (BCD). After tracheal intubation, the effect-site target concentration (Ce) of remifentanil was adjusted to achieve hemodynamic stability and reset to the level preoperatively assigned to each patient, according to the BCD method, approximately 10 min before head fixation. Baseline hemodynamic values were recorded before head fixation. An ineffective response was defined as a case with a > 20% increase in hemodynamic values from baseline. Otherwise, the response was determined to be effective. The EC90 of remifentanil was calculated as a modified isotonic estimator. Results Forty-three patients completed this study. The EC90 of remifentanil for blunting cardiovascular responses to head fixation was estimated to be 6.48 ng/mL (95% CI, 5.94–6.83 ng/mL). Conclusions Adjustment of the Ce of remifentanil to approximately 6.5 ng/mL before head fixation could prevent noxious cardiovascular responses in 90% of neurosurgical ASA I-II patients aged 20 to 65 years old during propofol target-controlled infusion titrated to maintain BIS between 40 and 50. Trial registration ClinicalTrials.gov Identifier NCT01489137 , retrospectively registered 5 December 2011. |
| first_indexed | 2024-12-14T22:51:43Z |
| format | Article |
| id | doaj.art-04036a6184714288947bcfd8e71e41e2 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-14T22:51:43Z |
| publishDate | 2017-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-04036a6184714288947bcfd8e71e41e22022-12-21T22:44:41ZengBMCBMC Anesthesiology1471-22532017-10-011711710.1186/s12871-017-0426-zThe EC90 of remifentanil for blunting cardiovascular responses to head fixation for neurosurgery under total intravenous anesthesia with propofol and remifentanil based on bispectral index monitoring: estimation with the biased coin up-and-down sequential methodJung-Man Lee0Jae-Hyon Bahk1Young-Jin Lim2Jiwon Lee3Leerang Lim4Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical CenterDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of MedicineDepartment of Anesthesiology and Pain Medicine, Keimyung University Dongsan Medical Center, Keimyung University College of MedicineDepartment of Anesthesiology and Pain Medicine, Seoul National University HospitalAbstract Background Head fixation can induce hemodynamic instability. Remifentanil is commonly used with propofol for total intravenous anesthesia (TIVA) during neurosurgery. This study investigated the 90% effective concentration (EC90) of remifentanil for blunting of cardiovascular responses to head fixation during neurosurgery via bispectral index (BIS) monitoring. Methods Fifty patients undergoing neurosurgery requiring head fixation were enrolled. This study was performed using the biased coin up-and-down design sequential method (BCD). After tracheal intubation, the effect-site target concentration (Ce) of remifentanil was adjusted to achieve hemodynamic stability and reset to the level preoperatively assigned to each patient, according to the BCD method, approximately 10 min before head fixation. Baseline hemodynamic values were recorded before head fixation. An ineffective response was defined as a case with a > 20% increase in hemodynamic values from baseline. Otherwise, the response was determined to be effective. The EC90 of remifentanil was calculated as a modified isotonic estimator. Results Forty-three patients completed this study. The EC90 of remifentanil for blunting cardiovascular responses to head fixation was estimated to be 6.48 ng/mL (95% CI, 5.94–6.83 ng/mL). Conclusions Adjustment of the Ce of remifentanil to approximately 6.5 ng/mL before head fixation could prevent noxious cardiovascular responses in 90% of neurosurgical ASA I-II patients aged 20 to 65 years old during propofol target-controlled infusion titrated to maintain BIS between 40 and 50. Trial registration ClinicalTrials.gov Identifier NCT01489137 , retrospectively registered 5 December 2011.http://link.springer.com/article/10.1186/s12871-017-0426-zHead fixationNeurosurgeryRemifentanil |
| spellingShingle | Jung-Man Lee Jae-Hyon Bahk Young-Jin Lim Jiwon Lee Leerang Lim The EC90 of remifentanil for blunting cardiovascular responses to head fixation for neurosurgery under total intravenous anesthesia with propofol and remifentanil based on bispectral index monitoring: estimation with the biased coin up-and-down sequential method BMC Anesthesiology Head fixation Neurosurgery Remifentanil |
| title | The EC90 of remifentanil for blunting cardiovascular responses to head fixation for neurosurgery under total intravenous anesthesia with propofol and remifentanil based on bispectral index monitoring: estimation with the biased coin up-and-down sequential method |
| title_full | The EC90 of remifentanil for blunting cardiovascular responses to head fixation for neurosurgery under total intravenous anesthesia with propofol and remifentanil based on bispectral index monitoring: estimation with the biased coin up-and-down sequential method |
| title_fullStr | The EC90 of remifentanil for blunting cardiovascular responses to head fixation for neurosurgery under total intravenous anesthesia with propofol and remifentanil based on bispectral index monitoring: estimation with the biased coin up-and-down sequential method |
| title_full_unstemmed | The EC90 of remifentanil for blunting cardiovascular responses to head fixation for neurosurgery under total intravenous anesthesia with propofol and remifentanil based on bispectral index monitoring: estimation with the biased coin up-and-down sequential method |
| title_short | The EC90 of remifentanil for blunting cardiovascular responses to head fixation for neurosurgery under total intravenous anesthesia with propofol and remifentanil based on bispectral index monitoring: estimation with the biased coin up-and-down sequential method |
| title_sort | ec90 of remifentanil for blunting cardiovascular responses to head fixation for neurosurgery under total intravenous anesthesia with propofol and remifentanil based on bispectral index monitoring estimation with the biased coin up and down sequential method |
| topic | Head fixation Neurosurgery Remifentanil |
| url | http://link.springer.com/article/10.1186/s12871-017-0426-z |
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