Suwarman Suwarman M. Andy Prihartono Galantry Ahmad Azhari

Keywords: Endotracheal intubation, Hemodynamic insult, Remifentanil

Abstract

Background & Objectives: Endotracheal intubation is one of the most potent stimuli as an integral part of general anesthesia with several risks such as a sudden increase in blood pressure and pulse rate. One of the drugs that can be used to prevent hemodynamic spikes in endotracheal intubation is remifentanil. It has rapid onset and peak effect with short duration of action. Various authors have used different doses of this drug. We compared the effect of two different doses of remifentanil on hemodynamic response to endotracheal intubation.

Methodology: It was a randomized clinical trial on 35 patients, aged 19-65 y, physical status ASA I-II, body mass index (BMI) 18.5-29.99 kg/m2, who underwent elective surgery under general anesthesia. Subjects were randomly assigned into 2 groups, Group R1, who received remifentanil 0.5 µg/kg intravenously (IV), followed by an infusion @ 0.1 µg/kg/min; and Group R2, who received remifentanil 1 µg/kg followed by 0.1 µg/kg/min intravenously. Systolic, diastolic and mean arterial pressure, and pulse rates were noted on arrival in the operating room T0, then measurements were performed 2 min after induction (T1), 1 min after intubation (T2), and continued at 3 and 5 min after intubation (T3 and T4). The data was analyzed with SPSS v21.0 for Windows. T-test or Mann-Whitney U test was performed to analyze the data.

Results: Based on this study, the hemodynamic parameters were significantly lower in systolic blood pressure (113.35 ± 4.66 vs. 107.83 ± 6.37, P = 0.008), diastolic blood pressure (68.88   vs. 61.83  P = 0.004), mean arterial pressure (83.76  vs. 77.28 ± 5.84, P = 0.001) and pulse rate (83.71 ± 8.20 vs. 76.11 ± 9.70, P = 0.013) after 1 min of endotracheal intubation in the remifentanil 1 µg/kg group compared to the 0.5 µg/kg remifentanil group.

Conclusion: Administration of remifentanil 1 µg/kg followed by maintenance of 0.1 g/kg/min can cause a statistically significant decrease in blood pressure and heart rate compared to remifentanil 0.5 µg/kg followed by maintenance of 0.1 µg/kg/min, when administered for endotracheal intubation.

Abbreviation: BMI: body mass index; IV: intravenously; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; MBP: Mean arterial blood pressure;

Key words: Endotracheal intubation; Hemodynamic insult; Remifentanil

Citation: Suwarman, Prihartono MA, Azhari GA. Comparison of two different doses of intravenous remifentanil on cardiovascular response to endotracheal intubation: a randomized controlled trial. Anaesth. pain intensive care 2022;26(6):778−783; DOI: 10.35975/apic.v26i6.2047

Author Biographies

Suwarman Suwarman

Department of Anesthesiology & Intensive Care, Faculty of Medicine, Padjadjaran University/ Dr. Hasan Sadikin Bandung General Hospital, Pasteur street, No.38, Bandung City, West Java, 40161, Indonesia.

M. Andy Prihartono

Department of Anesthesiology & Intensive Care, Faculty of Medicine, Padjadjaran University/ Dr. Hasan Sadikin Bandung General Hospital, Pasteur street, No.38, Bandung City, West Java, 40161, Indonesia

Galantry Ahmad Azhari

Department of Anesthesiology & Intensive Care, Faculty of Medicine, Padjadjaran University/ Dr. Hasan Sadikin Bandung General Hospital, Pasteur street, No.38, Bandung City, West Java, 40161, Indonesia.