Effects of dexmedetomidine on the median effective plasma concentration of remifentanil for excellent tracheal intubation during sevoflurane induction without neuromuscular blockade

doi:10.12092/j.issn.1009-2501.2019.08.012

Abstract

Abstract:

AIM: To explore the effects of dexmedetomidine on the 50% effective plasma concentration (Cp50) of remifentanil for excellent tracheal intubation during sevoflurane induction without neuromuscular blockade. METHODS: Forty-five patients undergoing selective general anesthesia were randomly assigned into two groups: infusion of 0.6 μg/kg dexmedetomidine over 15 min (group D, n=21), saline group (group C, n=24)．For induction, 8% sevoflurane induction was immediately begun in vital capacity until the loss of eyelash reflex, with end-tidal sevoflurane 3% subsequently was maintained. And the initial doses of remifentanil target-controlled infusion were set at 3 ng/mL for group D and 4 ng/mL for group C, and were decreased or increased by 0.2 ng/mL in the next patient using the Dixon's up-and-down method based on the success or failure of intubation. Laryngoscopy and intubation were performed, 90 s after achieving the target concentration of remifentanil. Tracheal intubation conditions and hemodynamics were recorded and compared.RESULTS:In group C and group D, the Cp50 of remifentanil for successful tracheal intubation were 3.079 ng/mL（95% CI 2.898-3.240）and 2.468 ng/mL（95% CI 2.239-2.630), respectively. CONCLUSION:Dexmedetomidine contributes to the reduced Cp50 of remifentanil by 19.8% for excellent tracheal intubation during sevoflurane induction without neuromuscular blockade．

Key words: dexmedetomidine, remifentanil, sevoflurane, intubation, target-controlled infusion (TCI)

CLC Number:

R614

LIAO Zhaoxia, ZHOU Lisheng, LU Fuding, LI Yujuan. Effects of dexmedetomidine on the median effective plasma concentration of remifentanil for excellent tracheal intubation during sevoflurane induction without neuromuscular blockade[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2019, 24(8): 922-927.

References

［1］Katz JA,Murphy GS.Anesthetic consideration for neuromuscular diseases［J］.Curr Opin Anaesthesiol,2017,30(3):435-440.
［2］Barrons RW,Nguyen LT.Succinylcholine-induced rhabdomyolysis in adults:case report and review of the literature［J］.J Pharm Pract,2018,29:897190018795983.
［3］Larach MG,Klumpner TT,Brandom BW,et al.Succinylcholine use and dantrolene availability for malignant hyperthermia treatment: database analyses and systematic review［J］.Anesthesiology,2019,130(1):41-54.
［4］Bulka CM,Terekhov MA,Martin BJ,et al.Nondepolarizing neuromuscular blocking agents,reversal,and risk of postoperative pneumonia［J］.Anesthesiology,2016,125:647-655.
［5］Goo EK,Lee JS,Koh JC.The optimal exhaled concentration of sevoflurane for intubation without neuromuscular blockade using clinical bolus doses of remifentanil［J］. Medicine,2017,96(9):e6235.
［6］Ono AH,Moura TR,Govêia CS,et al.ED50 of remifentanil for providing excellent intubating conditions when co-administered with a single standard dose of propofol without the use of muscle relaxants in children:dose-finding clinical trial［J］.J Anesth,2018,32(4):493-498.
［7］Heyse B,Proost JH,Hannivoort LN,et al.A response surface model approach for continuous measures of hypnotic and analgesic effect during sevoflurane-remifentanil interaction:quantifying the pharmacodynamic shift evoked by stimulation［J］.Anesthesiology,2014,120:1390-1399.
［8］赵鹏程,徐丽丽,李艳玲.右美托咪定联合靶控输注丙泊酚在肝癌射频消融治疗中的临床效果［J］.中国临床药理学与治疗学,2018,23(6):682-687.
［9］刘若海,韩园,刘启星,等.右美托咪定复合瑞芬太尼对全麻气管拔管反应的影响［J］.中国临床药理学与治疗学,2015,20(7):788-792.
［10］张宁, 郭振中, 程燕. 右美托咪定对肝叶切除患者肝功能、细胞因子及氧化应激的影响［J］. 临床肝胆病杂志, 2017, 33(3): 507-511.
［11］吕娜. 右美托咪定与咪达唑仑对小儿泌尿外科手术麻醉效果和血流动力学的影响比较［J］. 空军医学杂志, 2019, 35(1): 60-64.
［12］Dixon WJ. Staircase bioassay: the up-and-down method ［J］. Neurosci Biobehav Rev, 1991, 15: 47-50.
［13］Muzi M, Robinson BJ, Ebert TJ, et al. Induction of anaesthesia and tracheal intubation with sevoflurane in adults ［J］. Anesthesiology, 1996, 85: 536-543.
［14］Cros AM, Lopez C, Kandel T, et al. Determination of sevoflurane alveolar concentration for tracheal intubation with remifentanil, and no muscle relaxant ［J］. Anaesthesia, 2015, 55(10): 965-969.
［15］He L, Wang X, Zhang XF, et al. Effects of different doses of remifentanil on the end-tidal concentration of sevoflurane required for tracheal intubation in children ［J］. Anaesthesia, 2009, 64(8): 850-855.
［16］He L, Wang X, Zheng S, et al. Effects of dexmedetomidine on sevoflurane requirement for 50% excellent tracheal intubation in children: a randomized, double-blind comparison ［J］. Pediatr Anesth, 2014, 24(9): 987-993.
［17］杨慧芳, 孙建良, 陈淑萍, 等. 右美托咪啶对异丙酚靶控输注时瑞芬太尼抑制喉罩置入反应的半数有效血浆浓度的影响［J］. 浙江临床医学, 2015, (9): 1618-1619.
［18］de Kort EH, Hanff LM, Roofthooft D, et al. Insufficient sedation and severe side effects after fast administration of remifentanil during INSURE in preterm newborns ［J］. Neonatology, 2017, 111(2): 172-176.
［19］Bae JY, Kwak TY, Kim JW, et al. Tracheal intubation without the use of muscle relaxant in severe burn patients using propofol and varying doses of remifentanil ［J］. Korean J Anesthesiol, 2009, 57(1): 26-31.
［20］李婷, 王全, 刘曼. 七氟烷减轻急性肺损伤机制的研究进展［J］. 临床麻醉学杂志, 2017, 33(9): 931-933.

[1]	WU Xiongzhi, WANG Xuan, XU Siqi, JU Xia, WANG Shengbin, CHEN Yongquan. A comparative investigation of the impact of oral midazolam solution and dexmedetomidine nasal spray on preoperative anxiety in pediatric patients [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2023, 28(6): 666-670.
[2]	SHI Lingling, ZHANG Lei. Gene expression in rhesus macaques prefrontal cortex after multiple sevoflurane exposures [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2023, 28(4): 371-376.
[3]	REN Yixing, LENG Yufang, GUO Mingjun, ZHANG Jianmin, SHI Yajing, CHEN Feng, LIU Xin. Role and mechanism of SIRT3 in attenuation of intestinal ischemia-reperfusion injury by dexmedetomidine in mice [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2022, 27(3): 253-259.
[4]	LI Jiajia, CHEN Mengmeng, WANG Ruixian, HUANG Mengmeng, LI Jun, SHANGGUAN Wangning. Effects of alfentanil on tracheal intubation during tonsillectomy in children: A randomized double-blind study [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2022, 27(2): 184-189.
[5]	FAN Di, SHI Cuina, YANG Qingqing, JI Muhuo. Research progress on effects of sevoflurane anesthesia on developing brain [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2022, 27(12): 1333-1339.
[6]	YAN Lei, JIANG Haibin, NAFEISHA Paerhati, REZIWANGULI Yikemu, GENG Boyu, MAIERHABA Maimaitiaili. Effects of different doses of dexmedetomidine on non-cardiac surgery stress and postoperative sleep in patients with coronary heart disease [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2022, 27(12): 1340-1346.
[7]	HE Huan, XUE Zhenyu, MAO Haoli, ZHANG Lei. Effects of prolonged sevoflurane exposure on metabolomics of prefrontal cortex in aged mice [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2022, 27(12): 1375-1380.
[8]	ZHANG Jing, GAO Danyang, YU Kang, LIN Xiaowan, CAO Ying, LIU Xiao, MIAO Huihui, LI Tianzuo. Effects of different inhalation anesthetics on glial cells activation in neonatal rats [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2022, 27(12): 1391-1399.
[9]	WANG Ting, HAN Mingming, LI Juan. Effect of dexmedetomidine on muscle relaxant effect of cisatracurium in patients with epilepsy [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2022, 27(10): 1113-1118.
[10]	WU Xiaoxia, ZHOU Hu. Application of remifentanil in postoperative ICU sedation and analgesia in patients with severe craniocerebral trauma [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2022, 27(10): 1119-1124.
[11]	ZHANG Tianxue, ZHANG Lei, HAO Yingxiang, GAO Mingjing, WU Lin, LENG Yufang. Effect of SLC7A11 in dexmedetomidine pretreatment induced reduction of ferroptosis caused by intestinal ischemia-reperfusion injury in mice [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2021, 26(7): 738-743.
[12]	WU Wei, CHEN Zheng, DU Zhen, QU Shuangquan. Vinpocetine improves the long-term cognitive function of infant rats induced by sevoflurane via Wnt/GSK3β/β-catenin signaling pathway [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2021, 26(5): 539-545.
[13]	YANG Huifang, LUO Ying, ZHAO Li. Effects of dexmedetomidine on renal function and serum inflammatory factors in sepsis rats [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2020, 25(8): 857-861.
[14]	YANG Lu, WEI Bin, ZHANG Liping, BI Shanshan, LU Wei. Response surface model to optimize the concentration range of propofol and remifentanil [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2020, 25(4): 413-420.
[15]	PENG Wenyong, TU Wenlong, LIAO Junfeng, LAN Zhijian . Optimal dosage of dexmedetomidine on prevention of agitation induced by sevoflurane anesthesia in children [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2020, 25(1): 75-80.