Predicted EC50 and EC95 of Remifentanil for Smooth Removal of a Laryngeal Mask Airway Under Propofol Anesthesia
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Purpose: The purpose of this study was to determine the effect-site concentration (Ce) of remifentanil in 50% of patients (EC50) and 95% of patients (EC95) for smooth laryngeal mask airway (LMA) removal in adults under propofol and remifentanil anesthesia. Materials and Methods: Twenty-five patients of ASA physical status I‒II and ages 18‒60 years who were to undergo minor gynecological or orthopedic surgery were assessed in this study. Anesthesia was induced and maintained with propofol and remifentanil target-controlled infusion (TCI). Remifentanil was maintainedat a predetermined Ce during the emergence period. The modified Dixon’s up-and-down method was used to determine the remifentanil concentration, starting from 1.0 ng/mL (step size of 0.2 ng/mL). Successful removal of the LMA was regardedas absence of coughing/gagging, clenched teeth, gross purposeful movements,breath holding, laryngospasm, or desaturation to SpO2<90%. Results: The mean±SD Ce of remifentanil for smooth LMA removal after propofol anesthesia was 0.83±0.16 ng/mL. Using isotonic regression with a bootstrapping approach, the estimated EC50 and EC95 of remifentanil Ce were 0.91 ng/mL [95% confidence interval(CI), 0.77‒1.07 ng/mL] and 1.35 ng/mL (95% CI, 1.16‒1.38 ng/mL), respectively. Conclusion: Our results showed that remifentanil TCI at an established Ce is a reliable technique for achieving safe and smooth emergence without coughing, laryngospasm,or other airway reflexes.
Abstract
Purpose: The purpose of this study was to determine the effect-site concentration (Ce) of remifentanil in 50% of patients (EC50) and 95% of patients (EC95) for smooth laryngeal mask airway (LMA) removal in adults under propofol and remifentanil anesthesia. Materials and Methods: Twenty-five patients of ASA physical status I‒II and ages 18‒60 years who were to undergo minor gynecological or orthopedic surgery were assessed in this study. Anesthesia was induced and maintained with propofol and remifentanil target-controlled infusion (TCI). Remifentanil was maintainedat a predetermined Ce during the emergence period. The modified Dixon’s up-and-down method was used to determine the remifentanil concentration, starting from 1.0 ng/mL (step size of 0.2 ng/mL). Successful removal of the LMA was regardedas absence of coughing/gagging, clenched teeth, gross purposeful movements,breath holding, laryngospasm, or desaturation to SpO2<90%. Results: The mean±SD Ce of remifentanil for smooth LMA removal after propofol anesthesia was 0.83±0.16 ng/mL. Using isotonic regression with a bootstrapping approach, the estimated EC50 and EC95 of remifentanil Ce were 0.91 ng/mL [95% confidence interval(CI), 0.77‒1.07 ng/mL] and 1.35 ng/mL (95% CI, 1.16‒1.38 ng/mL), respectively. Conclusion: Our results showed that remifentanil TCI at an established Ce is a reliable technique for achieving safe and smooth emergence without coughing, laryngospasm,or other airway reflexes.
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