Concentrazioni al sito effettore di remifentanil capaci di mettere l'omeostasi cardiocircolatoria in risposta agli stimoli chirurgici durante anestesia con propofol BIS-guidata in pazienti gravemente obesi

Translated title of the contribution: Effect site concentrations of remifentanil maintaining cardiovascular homeostasis in response to surgical stimuli during bispectral index guided propofol anesthesia in seriously obese patients

Andrea Albertin, G. La Colla, L. La Colla, P. C. Bergonzi, F. Deni, E. Moizo

Research output: Contribution to journalArticle

Abstract

Aim. The aim of this prospective study was to determine the effect site concentrations of remifentanil maintaining cardiovascular homeostasis in response to surgical stimuli during bispectral index (BIS) guided propofol anesthesia in seriously obese patients. Methods. Twenty-two patients, female/male 15/7, ASA physical status II - III, aged 29-69 years, body mass index (BMI) 54.5±12 undergoing major open bariatric surgery, were enrolled to receive a propofol-remifentanil total intravenous anesthesia. All patients were intubated by using a flexible fiberoptic bronchoscopic technique facilitated by a target controlled effect site concentration of remifentanil set at 2.5 ng/mL. After endotracheal intubation, anesthesia was started with a target controlled infusion of propofol initially set at 6 μg/mL, then adjusted to maintain a BIS value between 40 and 50. The mean effect site concentration of remifentanil was recorded at different intervals time during surgery: skin incision-opening of peritoneum (T1), bowel resection (T2), cholecystojejunal anastomosis (T3), ileojejunal anastomosis (T4), closing of peritoneum (T5). Results. The mean plasma concentrations of propofol required to maintain a BIS value between 40 and 50 were 4±0.55, 3.8±0.64, 3.8± 0.63, 3.8±0.65 and 3.8±0.63 μg/mL, at T1, T2, T3, T4 and T5 interval time, respectively. The mean values of remifentanil target effect site concentration were 5.2±1.3, 7.71.7, 9.1±1.8, 9.7± 2.2 and 9.9±2.5 ng/mL at T1, T2, T3, T4 and T5 interval time. Conclusion. This study suggests that tolerance to remifentanil infusion is profound and develops very rapidly in morbidly obese patients submitted to open bariatric surgery during BIS guided propofol anesthesia. The administration of opiates during anesthesia based on target-controlled infusion should include corrections for the development of tolerance.

Original languageItalian
Pages (from-to)915-924
Number of pages10
JournalMinerva Anestesiologica
Volume72
Issue number11
Publication statusPublished - Nov 2006

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Propofol
Homeostasis
Anesthesia
Bariatric Surgery
Peritoneum
Endotracheal Anesthesia
Opiate Alkaloids
Dermatologic Surgical Procedures
Intravenous Anesthesia
Intratracheal Intubation
remifentanil
Body Mass Index
Prospective Studies

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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Concentrazioni al sito effettore di remifentanil capaci di mettere l'omeostasi cardiocircolatoria in risposta agli stimoli chirurgici durante anestesia con propofol BIS-guidata in pazienti gravemente obesi. / Albertin, Andrea; La Colla, G.; La Colla, L.; Bergonzi, P. C.; Deni, F.; Moizo, E.

In: Minerva Anestesiologica, Vol. 72, No. 11, 11.2006, p. 915-924.

Research output: Contribution to journalArticle

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title = "Concentrazioni al sito effettore di remifentanil capaci di mettere l'omeostasi cardiocircolatoria in risposta agli stimoli chirurgici durante anestesia con propofol BIS-guidata in pazienti gravemente obesi",
abstract = "Aim. The aim of this prospective study was to determine the effect site concentrations of remifentanil maintaining cardiovascular homeostasis in response to surgical stimuli during bispectral index (BIS) guided propofol anesthesia in seriously obese patients. Methods. Twenty-two patients, female/male 15/7, ASA physical status II - III, aged 29-69 years, body mass index (BMI) 54.5±12 undergoing major open bariatric surgery, were enrolled to receive a propofol-remifentanil total intravenous anesthesia. All patients were intubated by using a flexible fiberoptic bronchoscopic technique facilitated by a target controlled effect site concentration of remifentanil set at 2.5 ng/mL. After endotracheal intubation, anesthesia was started with a target controlled infusion of propofol initially set at 6 μg/mL, then adjusted to maintain a BIS value between 40 and 50. The mean effect site concentration of remifentanil was recorded at different intervals time during surgery: skin incision-opening of peritoneum (T1), bowel resection (T2), cholecystojejunal anastomosis (T3), ileojejunal anastomosis (T4), closing of peritoneum (T5). Results. The mean plasma concentrations of propofol required to maintain a BIS value between 40 and 50 were 4±0.55, 3.8±0.64, 3.8± 0.63, 3.8±0.65 and 3.8±0.63 μg/mL, at T1, T2, T3, T4 and T5 interval time, respectively. The mean values of remifentanil target effect site concentration were 5.2±1.3, 7.71.7, 9.1±1.8, 9.7± 2.2 and 9.9±2.5 ng/mL at T1, T2, T3, T4 and T5 interval time. Conclusion. This study suggests that tolerance to remifentanil infusion is profound and develops very rapidly in morbidly obese patients submitted to open bariatric surgery during BIS guided propofol anesthesia. The administration of opiates during anesthesia based on target-controlled infusion should include corrections for the development of tolerance.",
keywords = "Cardiovascular homeostasis, Obesity, Propofol, Remifentanil",
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T1 - Concentrazioni al sito effettore di remifentanil capaci di mettere l'omeostasi cardiocircolatoria in risposta agli stimoli chirurgici durante anestesia con propofol BIS-guidata in pazienti gravemente obesi

AU - Albertin, Andrea

AU - La Colla, G.

AU - La Colla, L.

AU - Bergonzi, P. C.

AU - Deni, F.

AU - Moizo, E.

PY - 2006/11

Y1 - 2006/11

N2 - Aim. The aim of this prospective study was to determine the effect site concentrations of remifentanil maintaining cardiovascular homeostasis in response to surgical stimuli during bispectral index (BIS) guided propofol anesthesia in seriously obese patients. Methods. Twenty-two patients, female/male 15/7, ASA physical status II - III, aged 29-69 years, body mass index (BMI) 54.5±12 undergoing major open bariatric surgery, were enrolled to receive a propofol-remifentanil total intravenous anesthesia. All patients were intubated by using a flexible fiberoptic bronchoscopic technique facilitated by a target controlled effect site concentration of remifentanil set at 2.5 ng/mL. After endotracheal intubation, anesthesia was started with a target controlled infusion of propofol initially set at 6 μg/mL, then adjusted to maintain a BIS value between 40 and 50. The mean effect site concentration of remifentanil was recorded at different intervals time during surgery: skin incision-opening of peritoneum (T1), bowel resection (T2), cholecystojejunal anastomosis (T3), ileojejunal anastomosis (T4), closing of peritoneum (T5). Results. The mean plasma concentrations of propofol required to maintain a BIS value between 40 and 50 were 4±0.55, 3.8±0.64, 3.8± 0.63, 3.8±0.65 and 3.8±0.63 μg/mL, at T1, T2, T3, T4 and T5 interval time, respectively. The mean values of remifentanil target effect site concentration were 5.2±1.3, 7.71.7, 9.1±1.8, 9.7± 2.2 and 9.9±2.5 ng/mL at T1, T2, T3, T4 and T5 interval time. Conclusion. This study suggests that tolerance to remifentanil infusion is profound and develops very rapidly in morbidly obese patients submitted to open bariatric surgery during BIS guided propofol anesthesia. The administration of opiates during anesthesia based on target-controlled infusion should include corrections for the development of tolerance.

AB - Aim. The aim of this prospective study was to determine the effect site concentrations of remifentanil maintaining cardiovascular homeostasis in response to surgical stimuli during bispectral index (BIS) guided propofol anesthesia in seriously obese patients. Methods. Twenty-two patients, female/male 15/7, ASA physical status II - III, aged 29-69 years, body mass index (BMI) 54.5±12 undergoing major open bariatric surgery, were enrolled to receive a propofol-remifentanil total intravenous anesthesia. All patients were intubated by using a flexible fiberoptic bronchoscopic technique facilitated by a target controlled effect site concentration of remifentanil set at 2.5 ng/mL. After endotracheal intubation, anesthesia was started with a target controlled infusion of propofol initially set at 6 μg/mL, then adjusted to maintain a BIS value between 40 and 50. The mean effect site concentration of remifentanil was recorded at different intervals time during surgery: skin incision-opening of peritoneum (T1), bowel resection (T2), cholecystojejunal anastomosis (T3), ileojejunal anastomosis (T4), closing of peritoneum (T5). Results. The mean plasma concentrations of propofol required to maintain a BIS value between 40 and 50 were 4±0.55, 3.8±0.64, 3.8± 0.63, 3.8±0.65 and 3.8±0.63 μg/mL, at T1, T2, T3, T4 and T5 interval time, respectively. The mean values of remifentanil target effect site concentration were 5.2±1.3, 7.71.7, 9.1±1.8, 9.7± 2.2 and 9.9±2.5 ng/mL at T1, T2, T3, T4 and T5 interval time. Conclusion. This study suggests that tolerance to remifentanil infusion is profound and develops very rapidly in morbidly obese patients submitted to open bariatric surgery during BIS guided propofol anesthesia. The administration of opiates during anesthesia based on target-controlled infusion should include corrections for the development of tolerance.

KW - Cardiovascular homeostasis

KW - Obesity

KW - Propofol

KW - Remifentanil

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