Remifentanil Decreases Sevoflurane Requirements to Block Autonomic Hyperreflexia During Transurethral Litholapaxy in Patients with High Complete Spinal Cord Injury
| Autor: | Hyung Kon Lee, Kyung J. Oh, Woong Mo Kim, Min H Shin, Sung S. Chung, Jong Un Lee, Seong Tae Jeong, Cheol Won Jeong, Seok Jai Kim, Kyung Yeon Yoo |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Methyl Ethers Remifentanil Hemodynamics Hyperreflexia Thoracic Vertebrae Sevoflurane Piperidines Urethra Lithotripsy Heart rate Humans Medicine Spinal Cord Injuries business.industry Middle Aged Anesthesiology and Pain Medicine Blood pressure Anesthesia Bispectral index Anesthetic Autonomic Dysreflexia Drug Therapy Combination Female medicine.symptom business medicine.drug |
| Zdroj: | Anesthesia & Analgesia. 112:191-197 |
| ISSN: | 0003-2999 |
| DOI: | 10.1213/ane.0b013e3181fc7139 |
| Popis: | BACKGROUND: An inhaled anesthetic concentration required to block autonomic hyperreflexia (AHR) is high enough to cause severe hypotension in patients with high spinal cord injury (SCI). We determined the effects of remifentanil on the sevoflurane requirement to block AHR in SCI. METHODS: The study involved 96 patients with chronic, complete SCI scheduled to undergo transurethral litholapaxy during general anesthesia. Anesthesia was induced with thiopental, and sevoflurane concentrations in 50% nitrous oxide were adjusted to maintain a bispectral index of 40 to 50. Whether the patient develops an AHR [an increase of systolic blood pressure (SBP) >20 to 40 mm Hg] was first examined by distending the bladder with glycine solution (the first trial). Patients who developed AHR were then allocated to receive no remifentanil infusion (control, n = 31), a target-controlled plasma concentration of 1 ng/mL (n = 25), or 3 ng/mL remifentanil (n = 24). After baseline hemodynamics had recovered, the target sevoflurane and remifentanil concentrations were maintained for at least 20 minutes and the procedure was resumed (the second trial). Each target sevoflurane concentration was determined by the up-and-down method based on changes (15% increase or more) of SBP in response to the bladder distension. SBP, heart rate, and bispectral index were measured before and during the bladder distension during the trials, and plasma concentrations of catecholamines during the first trial. RESULTS: Eighty-two (85.4%) of 96 patients developed AHR during the first trial, in which 2 were excluded because of hypotension (mean arterial blood pressure |
| Databáze: | OpenAIRE |
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