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Propofol sparing effect of remifentanil using closed-loop anaesthesia
S E Milne1, G N C Kenny, S Schraag
1University of Glasgow, Department of Anaesthesia, Glasgow Royal Infirmary, UK.
British Journal of Anaesthesia
|April 17, 2003
Summary
Increasing remifentanil concentrations significantly reduced propofol requirements for general anaesthesia. This synergistic effect between remifentanil and propofol optimizes anesthetic management during surgery.
Area of Science:
- Anesthesiology
- Pharmacology
- Surgical Care
Background:
- General anesthesia balances hypnosis and analgesia.
- Investigated remifentanil's impact on propofol dosage for anesthesia maintenance.
Purpose of the Study:
- To determine if higher remifentanil blood concentrations decrease propofol requirements.
- To assess the synergistic interaction between remifentanil and propofol.
Main Methods:
- 60 patients undergoing ambulatory surgery were randomized into three remifentanil groups (low, medium, high).
- Target-controlled infusions (TCI) of remifentanil and propofol were used, with auditory evoked potentials (AEPex) guiding propofol dosage.
- AEPex was maintained at 35 for comparable anesthesia levels across groups.
Main Results:
- Propofol requirements decreased dose-dependently with increasing remifentanil concentrations.
- Mean propofol concentrations were 4.96, 3.46, and 3.01 μg/mL for low, medium, and high remifentanil groups, respectively.
- No significant differences in recovery times were observed; however, cardiovascular changes were more pronounced at higher remifentanil doses.
Conclusions:
- Remifentanil and propofol exhibit a synergistic interaction during surgery.
- Remifentanil's contribution to anesthesia without stimulation appears limited.
- Propofol effect-site concentration can guide the recovery of consciousness.