Effect of Different Doses of Remifentanil on Hemodynamic Profiles and Intubation Conditions in Patients Undergoing Coronary Artery Bypass Graft Surgery, a Randomized Double-Blinded Placebo Controlled Trial

  • Sohrab Salimi Assistant Professor of Anesthesiology, Department of Anesthesiology and Critical Care, Emam Hussain Hospital, Shahid Beheshti University of Medical Sciences,Tehran,Iran.
  • Morteza Jabbari Moghaddam Assistant Professor of Anesthesiology, Department of Anesthesiology and Critical Care, Emam Hussain Hospital, Shahid Beheshti University of Medical Sciences,Tehran,Iran.
  • Noushin Khazaei Resident of Anesthesiology, Department of Anesthesiology and Critical Care, Emam Hussain Hospital, Shahid Beheshti University of Medical Sciences,Tehran,Iran.
  • Ali Movafegh Professor of Anesthesiology, Department of Anesthesiology and Critical Care,Dr. Shariati hospital, Tehran University of Medical Sciences
  • Omid Azimaraghi Assistant Professor of Anesthesiology, Department of Anesthesiology and Critical Care,Dr. Shariati hospital, Tehran University of Medical Sciences
  • Reza Atef Yekta Assistant Professor of Anesthesiology, Department of Anesthesiology and Critical Care, Dr. Shariati hospital, Tehran University of Medical Sciences
  • Alireza Saliminia Assistant Professor of Anesthesiology, Department of Anesthesiology and Critical Care,Dr. Shariati hospital, Tehran University of Medical Sciences
  • Seyed Sajjad Razavi Associate Professor of Anesthesia, Mofid Hospital, Shahid Beheshti Medical University, Tehran, Iran.
Keywords: remifentanil, tracheal intubation, cardiovascular response

Abstract

Background: Hemodynamic instability is common during tracheal intubation. The primary purpose of the present study is to evaluate the effect of different doses of remifentanil added to propofol on the hemodynamic profiles during tracheal intubation.Methods: Ninety patients, 40 to 70 years old, undergoing coronary artery bypass graft surgery under general anesthesia were randomly allocated into control, low (2µg/kg) and high (4ug/kg) dose groups. Baseline heart rate (HR), mean arterial pressure (MAP) were recorded and documented again on intubation and 1, 2 and 4 minutes after intubation. Cough status before and after intubation was also recorded.Results: The basic characteristics of participants in all the three groups were similar. Heart rate and blood pressure decreased in all three groups after intubation. There was no difference in the intubation conditions and mask ventilation or coughing between the three groups.Conclusion: There was no significant difference observed between hemodynamic changes with high and low dose of remifentanil to attenuate the rise in MAP on intubation.

References

Mort TC. Complications of emergency tracheal intubation: hemodynamic alterations-Part I. J Intensive Care Med. 2007; 22(3):157-65.

Shrestha M, Rahman TR, Agarwal B. Hemodynamic changes during endotracheal intubation: A prospective randomised comparative study using fibreoptic bronchoscope and intubating laryngeal mask airway. Journal of Society of Anesthesiologists of Nepal. 2014; 1(2):70-5.

Hassani V, Movassaghi G, Goodarzi V, Safari S. Comparison of fentanyl and fentanyl plus lidocaine on attenuation of hemodynamic responses to tracheal intubation in controlled hypertensive patients undergoing general anesthesia. Anesth Pain Med. 2013; 2(3):115-8.

Guignard B, Menigaux C, Dupont X, Fletcher D, Chauvin M. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg. 2000; 90(1):161-7.

Tuzcu K, Tuzcu EA, Karcioglu M, Davarci I, Coskun M, Ilhan O, et al. The Effects of Remifentanil and Esmolol on Increase in Intraocular Pressure Due to Laryngoscopy and Tracheal Intubation: A Double-Blind, Randomized Clinical Trial. J Glaucoma. 2015; 24(5):372-6.

Sunil R, Vijay S, Jerry P. The role of intravenous magnesium sulphate in attenuating pressor response to laryngoscopy and intubation in patients undergoing major head and neck surgeries. Ain-Shams Journal of Anaesthesiology. 2014; 7(3):451-5.

Zhang GH, Sun L. Peri-intubation hemodynamic changes during low dose fentanyl, remifentanil and sufentanil combined with etomidate for anesthetic induction. Chin Med J (Engl). 2009; 122(19):2330-4.

Schlaich N, Mertzlufft F, Soltesz S, Fuchs‐Buder T. Remifentanil and propofol without muscle relaxants or with different doses of rocuronium for tracheal intubation in outpatient anaesthesia. Acta Anaesthesiol Scand. 2000; 44(6):720-6.

Barclay K, Eggers K, Asai T. Low-dose rocuronium improves conditions for tracheal intubation after induction of anaesthesia with propofol and alfentanil. Br J Anaesth. 1997; 78(1):92-4.

Stevens JB, Wheatley L. Tracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants. Anesth Analg. 1998; 86(1):45-9.

Grant S, Noble S, Woods A, Murdoch J, Davidson A. Assessment of intubating conditions in adults after induction with propofol and varying doses of remifentanil. Br J Anaesth. 1998; 81(4):540-3.

Klemola UM, Mennander S, Saarnivaara L. Tracheal intubation without the use of muscle relaxants: remifentanil or alfentanil in combination with propofol. Acta Anaesthesiol Scand. 2000; 44(4):465-9.

Alexander R, Olufolabi AJ, Booth J, El‐Moalem HE, Glass PS. Dosing study of remifentanil and propofol for tracheal intubation without the use of muscle relaxants. Anaesthesia. 1999; 54(11):1037-40.

Geldner G, Wulf H. Muscle relaxants suitable for day case surgery. Eur J Anaesthesiol Suppl. 2001; 23:43-6.

Meakin GH. Muscle relaxants in paediatric day case surgery. Eur J Anaesthesiol Suppl. 2001; 23:47-52.

Published
2016-08-10
How to Cite
1.
Salimi S, Jabbari Moghaddam M, Khazaei N, Movafegh A, Azimaraghi O, Atef Yekta R, Saliminia A, Razavi SS. Effect of Different Doses of Remifentanil on Hemodynamic Profiles and Intubation Conditions in Patients Undergoing Coronary Artery Bypass Graft Surgery, a Randomized Double-Blinded Placebo Controlled Trial. AACC. 2(3):207-9.
Section
Research Article(s)