Desflurane-remifentanil-nitrous oxide anaesthesia for abdominal surgery: optimal concentrations and recovery features

Background:  Intraoperative combinations of volatile and opioid agents are used to achieve unconsciousness, hypnotic sparing, haemodynamic stability and uneventful recovery. This study describes the influence of different remifentanil concentrations on these variables when combined with desflurane d...

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Bibliographic Details
Published in:Acta anaesthesiologica Scandinavica 2004-03, Vol.48 (3), p.355-364
Main Authors: Billard, V., Servin, F., Guignard, B., Junke, E., Bouverne, M. N., Hédouin, M., Chauvin, M.
Format: Article
Language:English
Subjects:
Abdomen - surgery
Abdominal
Acetaminophen - analogs & derivatives
Acetaminophen - therapeutic use
Adult
Analgesia, Patient-Controlled
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - therapeutic use
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthetics, Inhalation - administration & dosage
Anti-Inflammatory Agents, Non-Steroidal - therapeutic use
Biological and medical sciences
bispectral
Blood Pressure - drug effects
desflurane
drug interactions
Electroencephalography - drug effects
Female
haemodynamics
Heart Rate - drug effects
Humans
Hypotension - prevention & control
Isoflurane - administration & dosage
Isoflurane - analogs & derivatives
Male
Medical sciences
Middle Aged
Morphine - therapeutic use
Nitrous Oxide - administration & dosage
Piperidines - administration & dosage
Recovery of Function
remifentanil
surgery
Tachycardia - prevention & control
target-controlled infusion
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Summary:Background:  Intraoperative combinations of volatile and opioid agents are used to achieve unconsciousness, hypnotic sparing, haemodynamic stability and uneventful recovery. This study describes the influence of different remifentanil concentrations on these variables when combined with desflurane during abdominal surgery. Methods:  Sixty‐one healthy adult patients were randomly allocated to one of five predefined remifentanil target concentrations (3, 5, 7, 10 or 15 ng ml−1). Anaesthesia was titrated to maintain mean blood pressure (MBP), heart rate (HR) and BIS™ within predetermined values by adjusting desflurane delivery. Postoperative analgesia using propacetamol and morphine was initiated 30–45 min before skin closure, and continued using morphine PCA. Results:  Desflurane requirements adjusted to both BIS and haemodynamics were not significantly modified by the remifentanil concentration (median FetDES 2.7% before incision, 2.5% intraoperatively, and 2.2% during closure), resulting in a calculated drug consumption of 0.22–0.25 ml min−1 (with 1.5 l min−1 fresh gas flow). High remifentanil concentration decreased MBP and HR, and reduced the duration of tachycardia, but increased the duration of hypotension. The optimal balance was obtained with a remifentanil concentration of 5–7 ng ml−1 for intubation, 3 ng ml−1 until incision, 10 ng ml−1 during intra‐abdominal surgery and 5–7 ng ml−1 during closure. Post‐operative morphine requirements were not significantly modified by intraoperative remifentanil concentrations (median 30 mg/24 h, range [2–88]). Conclusion:  Remifentanil target concentrations from 3 to 15 ng ml−1 had little influence on desflurane requirements or postoperative morphine consumption, but markedly modified intraoperative haemodynamic stability, suggesting that the target concentration should closely follow the successive noxious stimulations.
ISSN:0001-5172
1399-6576
DOI:10.1111/j.0001-5172.2004.0324.x