Optimal effect-site concentration of remifentanil to prevent hemodynamic changes during nasotracheal intubation using a video laryngoscope
윤지영, Park Chul-Gue, 김은정, 최병문, 윤지욱, 김연하, 이문옥, 한기섭, 안지혜,
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윤지영 ( Yoon Ji-Young ) - Pusan National University School of Dentistry Department of Dental Anesthesia and Pain Medicine
( Park Chul-Gue ) - Pusan National University School of Dentistry Department of Dental Anesthesia and Pain Medicine
김은정 ( Kim Eun-Jung ) - Pusan National University School of Dentistry Department of Dental Anesthesia and Pain Medicine
최병문 ( Choi Byung-Moon ) - University of Ulsan College of Medicine Asan Medical Center Department of Anesthesiology and Pain Medicine
윤지욱 ( Yoon Ji-Uk ) - Pusan National University School of Medicine Department of Anesthesia and Pain Medicine
김연하 ( Kim Yeon-Ha ) - Pusan National University Department of Integrated Biological Science
이문옥 ( Lee Moon-Ok ) - Sungkyunkwan University School of Medicine Samsung Changwon Hospital Department of Anesthesiology and Pain Medicine
한기섭 ( Han Ki-Seob ) - Sungkyunkwan University School of Medicine Samsung Changwon Hospital Department of Anesthesiology and Pain Medicine
안지혜 ( Ahn Ji-Hye ) - Pusan National University School of Dentistry Department of Dental Anesthesia and Pain Medicine
Abstract
Background: Nasotracheal intubation is the most commonly used method to secure the field of view when performing surgery on the oral cavity or neck. Like orotracheal intubation, nasotracheal intubation uses a laryngoscope. Hemodynamic change occurs due to the stimulation of the sympathetic nervous system. Recently, video laryngoscope with a camera attached to the end of the direct laryngoscope blade has been used to minimize this change. In this study, we investigated the optimal effect-site concentration (Ce) of remifentanil for minimizing hemodynamic responses during nasotracheal intubation with a video laryngoscope.
Methods: Twenty-one patients, aged between 19 and 60 years old, scheduled for elective surgery were included in this study. Anesthesia was induced by slowly injecting propofol. At the same time, remifentanil infusion was initiated at 3.0 ng/ml via target-controlled infusion (TCI). When remifentanil attained the preset Ce, nasotracheal intubation was performed using a video laryngoscope. The patient's blood pressure and heart rate were checked pre-induction, right before and after intubation, and 1 min after intubation. Hemodynamic stability was defined as an increase in systolic blood pressure and heart rate by 20% before and after nasotracheal intubation. The response of each patient determined the Ce of remifentanil for the next patient at an interval of 0.3 ng/ml.
Results: The Ce of remifentanil administered ranged from 2.4 to 3.6 ng/ml for the patients evaluated. The estimated optimal effective effect-site concentrations of remifentanil were 3.22 and 4.25 ng/ml, that were associated with a 50% and 95% probability of maintaining hemodynamic stability, respectively.
Conclusion: Nasotracheal intubation using a video laryngoscope can be successfully performed in a hemodynamically stable state by using the optimal remifentanil effect-site concentration (Ce50, 3.22 ng/ml; Ce95, 4.25 ng/ml).
키워드
Effect-Site Concentration; Nasotracheal Intubation; Remifentanil; Video Laryngoscopes
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