Supreme laryngeal mask airway for cesarean section under general anesthesia: a 10-year retrospective cohort study.

Background: Previous research showed the use of supraglottic airways in obstetric anesthesia. The relevant evidence of laryngeal mask airway (LMA) on maternal and neonatal outcomes is still limited. We aimed to assess the maternal and neonatal outcomes when the LMA Supreme was used for cesarean section under general anesthesia. Methods: We included all patients who underwent general anesthesia for cesarean section between January 2010 and December 2019. Propensity score matching was used to reduce potential bias from non-random selection of airway intervention. The primary outcome was adverse maternal and neonatal outcomes defined as maternal regurgitation, aspiration, hypoxemia, and low neonatal Apgar scores. Secondary outcomes included patient admission to the intensive care unit, neonate required tracheal intubation, external cardiac massage, and admission to the neonatal intensive care unit. Results: A total of 723 patients were included in the analysis; of whom, 221 received Supreme laryngeal mask airway (LMA group) and 502 were intubated with an endotracheal tube (ETT group). After propensity score matching, 189 patients remained in each group. No episode of regurgitation and aspiration occurred in both groups. There was no difference in the rates of Apgar score below 7 at 1 min (14.3% LMA group vs. 15.3% ETT group, OR 0.931, 95% CI 0.574 to 1.510, P = 0.772) and 5 min (3.7% vs. 4.2%, OR 0.875, 95% CI 0.324 to 2.365, P = 0.792). No difference was observed in the secondary outcomes between the two groups. Conclusion: The LMA Supreme was not associated with higher adverse maternal and neonatal outcomes when compared to an endotracheal tube for cesarean section under general anesthesia. It might be considered an alternative to tracheal intubation in obstetric practice.

Epidural hydroxyethyl starch ameliorating postdural puncture headache after accidental dural puncture.

BACKGROUND: No convincing modalities have been shown to completely prevent postdural puncture headache (PDPH) after accidental dural puncture (ADP) during obstetric epidural procedures. We aimed to evaluate the role of epidural administration of hydroxyethyl starch (HES) in preventing PDPH following ADP, regarding the prophylactic efficacy and side effects. METHODS: Between January 2019 and February 2021, patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital. The development of PDPH, severity and duration of headache, adverse events associated with prophylactic strategies, and hospital length of stay postpartum were reported. RESULTS: A total of 105 patients experiencing ADP received a re-sited epidural catheter. For PDPH prophylaxis, 46 patients solely received epidural analgesia, 25 patients were administered epidural HES on epidural analgesia, and 34 patients received two doses of epidural HES on and after epidural analgesia, respectively. A significant difference was observed in the incidence of PDPH across the groups (epidural analgesia alone, 31 [67.4%]; HES-Epidural analgesia, ten [40.0%]; HES-Epidural analgesia-HES, five [14.7%]; P <0.001). No neurologic deficits, including paresthesias and motor deficits related to prophylactic strategies, were reported from at least 2 months to up to more than 2 years after delivery. An overall backache rate related to HES administration was 10%. The multivariable regression analysis revealed that the HES-Epidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP (OR = 0.030, 95% confidence interval: 0.006-0.143; P < 0.001). CONCLUSIONS: The incorporated prophylactic strategy was associated with a great decrease in the risk of PDPH following obstetric ADP. This strategy consisted of re-siting an epidural catheter with continuous epidural analgesia and two doses of epidural HES, respectively, on and after epidural analgesia. The efficacy and safety profiles of this strategy have to be investigated further.

Anesthetic management of a child with congenital insensitivity to pain with anhidrosis: A case report.

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare, autosomal recessive disease classified as hereditary sensory and autonomic neuropathy type VI. Patients with CIPA are characterized by insensitivity to pain, episodes of unexplained fever, anhidrosis, self-mutilating behavior, intellectual disability, and autonomic nervous system abnormalities. The clinical features may intrinsically pose anesthetic challenges. We present a case of a patient with CIPA who underwent tumor biopsy under general anesthesia using a Supreme laryngeal mask airway without any complications. The anesthetic management of this condition is discussed.

The impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery: a randomized controlled trial.

BACKGROUND: Our objective was to evaluate the impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery. METHODS: One hundred forty female patients scheduled for laparoscopic gynecological surgery were enrolled in this prospective, randomized controlled trial. Participants were randomized to receive either multimodal analgesia (Study group) or conventional opioid-based analgesia (Control group). The multimodal analgesic protocol consists of pre-operative acetaminophen and gabapentin, intra-operative flurbiprofen and ropivacaine, and post-operative acetaminophen and celecoxib. Both groups received an on-demand mode patient-controlled analgesia pump containing morphine for rescue analgesia. The primary outcome was Quality of Recovery-40 score at postoperative day (POD) 2. Secondary outcomes included numeric pain scores (NRS), opioid consumption, clinical recovery, C-reactive protein, and adverse events. RESULTS: One hundred thirty-eight patients completed the study. The global QoR-40 scores at POD 2 were not significantly different between groups, although scores in the pain dimension were higher in Study group (32.1 ± 3.0 vs. 31.0 ± 3.2, P = 0.033). In the Study group, NRS pain scores, morphine consumption, and rescue analgesics in PACU (5.8% vs. 27.5%; P = 0.0006) were lower, time to ambulation [5.0 (3.3-7.0) h vs. 6.5 (5.0-14.8) h; P = 0.003] and time to bowel function recovery [14.5 (9.5-19.5) h vs.17 (13-23.5) h; P = 0.008] were shorter, C-reactive protein values at POD 2 was lower [4(3-6) ng/ml vs. 5 (3-10.5) ng/ml; P = 0.022] and patient satisfaction was higher (9.8 ± 0.5 vs. 8.8 ± 1.2, P = 0.000). CONCLUSION: For minimally invasive laparoscopic gynecological surgery, multimodal analgesia based enhanced recovery protocol offered better pain relief, lower opioid use, earlier ambulation, faster bowel function recovery and higher patient satisfaction, while no improvement in QoR-40 score was found. TRIAL REGISTRATION: ChiCTR1900026194 ; Date registered: Sep 26,2019.

Epidural analgesia followed by epidural hydroxyethyl starch prevented post-dural puncture headache: Twenty case reports and a review of the literature.

BACKGROUND: Accidental dural puncture (ADP) and subsequent post-dural puncture headache (PDPH) remain common complications of epidural procedures for obstetric anesthesia and analgesia. No clear consensus exists on the best way to prevent PDPH after ADP. CASE SUMMARY: We report our findings in twenty parturients who underwent an incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch (HES) to prevent PDPH after ADP with a 16-gauge Tuohy needle during epidural procedures. ADP with a 16-gauge Tuohy needle occurred in nine parturients undergoing a cesarean section (CS) and in eleven parturients receiving labor analgesia. An epidural catheter was re-sited at the same or adjacent intervertebral space in all patients. After CS, the epidural catheter was used for postoperative pain relief over a 48-h period. After delivery in eleven cases, epidural infusion was maintained for 24 h. Thereafter, 15 mL of 6% HES 130/0.4 was administered via the epidural catheter immediately prior to catheter removal. None of the parturients developed PDPH or neurologic deficits over a follow-up period of at least two months to up to one year postpartum. CONCLUSION: An incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch may have great efficacy in preventing PDPH after ADP.

Dynamic variables predict fluid responsiveness in pre-school and school children undergoing neurosurgery: a prospective observational study.

BACKGROUND: The evidence that plethysmographic variability index (PVI), pulse pressure variation (PPV), FloTrac/Vigileo-derived stroke volume variation (SVV), and Eadyn (dynamic arterial elastance) predict fluid responsiveness in children is limited by conflicting results. We aim to evaluate their accuracy and reliability to predict fluid responsiveness after induction in children aged 4-9 years undergoing major neurosurgery. METHODS: Children aged 4-9 years undergoing intracranial epileptic foci excision were enrolled. After the induction of anesthesia, fluid loading with 10 mL/kg of Ringer's solution over 10 min was administered before surgical incision. PVI, PPV, SVV, and Eadyn were measured before and within 5 min after fluid loading. Respiratory variation in aortic blood flow peak velocity (∆Vpeak) >15% at baseline, measured using transthoracic echocardiography, identified fluid "responders". The abilities of dynamic variables to predict an increase in mean arterial pressure (MAP) of >10% following fluid loading were also assessed. RESULTS: Fourteen (31.8%) of forty-four patients were responders defined by a baseline ∆Vpeak >15%. Before fluid loading, only the PVI value was significantly different between R and NR (P=0.017). Baseline PVI showed fair diagnostic accuracy for fluid responsiveness, with an area under the curve (AUROC) of 0.735 and the cutoff value of 13%. The R group showed a significantly greater absolute change in PPV and SVV after fluid loading from baseline compared with the NR group (P=0.021 and 0.040, respectively). The absolute change in the PPV and SVV values from baseline was greater in R than those in NR (P=0.021 and 0.040, respectively). Twenty (45.5%) showed a MAP increase of >10% following fluid loading and were defined as responders. Baseline ∆Vpeak and SVV showed fair predictive values for a MAP increase of >10% (AUROC =0.758 and 0.715, respectively). CONCLUSIONS: PVI at baseline showed fair reliability to predict fluid responsiveness after anesthesia induction in mechanically ventilated children aged 4-9 years undergoing neurosurgery. Baseline ∆Vpeak and SVV were fairly predictive for an increase in MAP following fluid loading.

Comparison of the ultrasound-guided single-injection femoral triangle block versus adductor canal block for analgesia following total knee arthroplasty: a randomized, double-blind trial.

PURPOSE: The aim of the study is to compare the femoral triangle (FT) and adductor canal (AC) blocks in terms of the analgesic efficacy and ambulatory outcomes in the context of multimodal analgesia following total knee arthroplasty (TKA). METHODS: Patients presenting for TKA were assigned to a preoperative ultrasound-guided single-injection FT or AC block. Combined spinal and epidural anesthesia with bupivacaine was administered for TKA. Perioperatively a multimodal analgesic regimen was applied up to 48 h after surgery. The primary outcome was the average pain score during movement in the first 24 h postoperatively. The secondary outcomes included pain scores at rest and during movement at postoperative predetermined time points, cumulative opioid consumption in oral morphine equivalents, functional mobility measured by the timed "Up and Go" (TUG) test and muscle strength in the lower extremity. RESULTS: Ninety-eight patients completed the study. Patients in the FT group had lower median pain scores during movement in the first 24 h postoperatively than those in the AC group (1.3 [1.0-3.3] vs. 3.0 [1.7-4.3]; median difference: - 1.0, adjusted 95% CI from - 1.7 to - 0.3, P = 0.010). There were significant differences in the pain scores at rest and during movement at 12 and 24 h postoperatively between the two groups (P = 0.008 and 0.005, respectively). Cumulative oral morphine equivalent consumption in the first and second 24 h postoperatively, Functional mobility reflected by the TUG test and muscle strength in the lower extremity showed no significantly statistically differences between the two groups. CONCLUSIONS: The preoperative FT block provided improved analgesic outcomes without compromising functional mobility in the context of multimodal analgesia following TKA compared with the AC block. TRIAL REGISTRATION: https://www.chictr.org.cn . Identifier: ChiCTR-INR-17012716.

Laryngeal Mask Airway for Cesarean Delivery: A 5-Year Retrospective Cohort Study.

BACKGROUND: The laryngeal mask airway (LMA) is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery (CD) for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia (GA). METHODS: We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation (ET) group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups. RESULTS: During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications for GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases (68.9%) and LMA in 56 cases (31.1%). The percentage of critical patients above the American Society of Anesthesiologists' Grade II was 24/124 in ET group and 4/56 in LMA group (P = 0.036). The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group (P = 0.001). None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups. CONCLUSIONS: Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies.

Intra-operative dexmedetomidine reduces early postoperative nausea but not vomiting in adult patients after gynaecological laparoscopic surgery: A randomised controlled trial.

BACKGROUND: Few studies have investigated the use of dexmedetomidine in patients with a high risk of postoperative nausea and vomiting (PONV) following gynaecological laparoscopic surgery. OBJECTIVE: To investigate if the intra-operative use of dexmedetomidine could reduce the incidence of PONV in this patient population. DESIGN: A randomised, double-blind, placebo-controlled trial. SETTING: A tertiary hospital in Beijing, China. PATIENTS: 130 adult patients scheduled for gynaecological laparoscopic surgery. INTERVENTIONS: Patients in the dexmedetomidine group (Dex group, n = 65) received a loading dose of dexmedetomidine (0.5 µg kg over 10 min) before induction of anaesthesia, followed by a continuous infusion (0.1 µg kg h) until the end of surgery. Patients in the control group (Ctrl group, n = 65) received volume-matched normal saline. Propofol and remifentanil were used for induction and maintenance of anaesthesia. Intravenous patient-controlled analgesia with morphine was provided after surgery. MAIN OUTCOME MEASURES: The incidence of 24-h PONV. RESULTS: The incidence of nausea within the first 2 postoperative hours was lower in the Dex group than in the Ctrl group [0% (0/65) vs. 9% (6/65), P = 0.037]. The overall incidence of PONV within the first 2 postoperative hours was slightly lower in the Dex group than in the Ctrl group, but the difference was not statistically significant [5% (3/65) vs. 14% (9/65), P = 0.069]. There was no significant difference between the two groups regarding the incidence of 24-h PONV. CONCLUSION: For adult patients undergoing gynaecological laparoscopic surgery, supplemental use of dexmedetomidine during general anaesthesia reduced the incidence of early postoperative nausea but not vomiting within the 24 h after surgery. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-IPR-15006914.

[Neuromuscular effects of cisatracurium besylate in obese patients].

OBJECTIVE: To explore the neuromuscular effects of cisatracurium besylate in morbidly obese patients when dosed according to real body weight under total intravenous anesthesia with propofol. METHODS: Thirty-six ASA I-II patients aged 18-65 years scheduled for elective procedures at our hospital during July 2012 to December 2012 were allocated into 2 groups according to body mass index (normal weight: body mass index: <24, overweight: body mass index >28). Anesthesia was induced with target-controlled infusion of propofol (Cp 3 µg/ml) and remifentanil (Ce 3-5 ng/ml). A bolus of cisatracurium 0.2 mg/kg was administered intravenously over 5-10 s as soon as a patient lost consciousness. Neuromuscular block was monitored with TOF-Watch SX (Oaganon, the Netherlands). Single stimulation (0.1 Hz) was applied to ulnar nerve at wrist. The maximal degree of neuromuscular block, onset time, clinical duration and recovery index were recorded. They were intubated and mechanically ventilated when neuromuscular block reached the maximal degree. The intubation condition was evaluated. RESULTS: The average onset time was (164 ± 25) s in obese group versus (201 ± 48) s in normal weight group. And there was significant difference between groups (t = 2.83, P < 0.05) . The clinical duration was (68.4 ± 9.6) min in obese group versus (62.0 ± 6.5) min in normal weight group. And there was significant difference between groups (t = 2.33, P < 0.05). The recovery index was (15.6 ± 4.7) min in obese group versus (10.8 ± 4.2) min in normal weight group. And there was significant difference between groups (t = 3.03, P < 0.05) . Also 75% recovery time was (83.9 ± 11.5) min in obese group versus (73.0 ± 9.2) min in normal weight group. And there was significant difference between groups (t = 2.94, P < 0.05). But no differences existed in intubation conditions. CONCLUSION: When dosed according to real body weight, onset time of cisatracurium is shorter while clinical duration and recovery index are prolonged in morbidly obese patients compared with normal weight counterparts.

[Effect of multimodal-antiemetic therapy on postoperative nausea and vomiting in patients undergoing gynecological laparoscopy: a randomized controlled study].

OBJECTIVE: To evaluate the efficacy of multimodal-antiemetic therapy on postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopy. METHODS: 129 patients scheduled for gynecological laparoscopy were randomly allocated to a multimodal-antiemetic group (group M, with 65 cases) or an ondansetron control group (group C, with 64 cases). In group M patients received a target-controlled infusion of propofol and remifentanil, prophylactic dexamethasone 10 mg and tropisetron 4 mg were given and parecoxib sodium 40 mg was used 30 minutes before the end of surgery. In group C patients received sevoflurane and 50% nitrous oxide. Prophylactic ondansetron 4 mg was given to patients 30 min before the end of surgery. The incidence of nausea and vomiting, use of rescue antiemetic drugs were recorded for 24 h. RESULTS: 24 h after surgery, the incidence of patients who suffered PONV was significantly lower in Group M compared with Group C (29% vs 70%, P < 0.05). At 0 - 2 h, 2 - 6 h, 6 - 24 h after surgery, the incidences of PONV were 8%, 6% and 25% for group M respectively, significantly lower than those for group C, which were 33%, 30% and 66% respectively(P < 0.05). CONCLUSIONS: Multimodal-antiemetic therapy; a regimen including total intravenous anaesthesia with propofol and remifentanil, prophylactic antiemetic (dexamethasone at induction and tropisetron at end of surgery), and multimodal analgesia with parecoxib sodium could significantly reduce the incidence of PONV after gynecological laparoscopy.

[Role of target controlled infusion of remifentanil for the prevention of etomidate induced myoclonus during general anesthesia].

OBJECTIVE: To explore the preventive effect of etomidate-induced myoclonus by different concentrations of target-controlled infusion of remifentanil. METHODS: A total of 120 cases undergoing general anesthesia were randomly divided into 4 groups according to different concentrations of target controlled infusion of remifentanil using plasma target controlled infusion ( Minto model) , in which the target concentration was set as 1 f.Lg/L ( group A) , 2 f.Lg/L ( group B) , 3 f.Lg/L ( group C) , and 4 f.Lg/L ( group D) . Five minutes after the balance of effect compartment, induction with etomidate 0. 3 mglkg was conducted intravenously. The intensity and duration of myoclonus was recorded. RESULTS: The incidence of etomidate-induced myoclonus was 70.9%, 33.3%, 26.7%, and 0 in groups A, B, C, and D, respectively. Along with the increase of the remifentanil concentration, the incidence of severe myoclonus gradually reduced, which was significantly lower in group B and C than in group A ( P < 0. 05). When the concentration reached 4 f.Lg/L, bradycardia and apnea appeared. CONCLUSION: Myoclonus induced by etomidate under general anesthesia can be prevented by target controlled infusion of remifentanil, with 2-3 f.Lg/L being the optimal concentration.

Minimum effective local anesthetic dose of intrathecal hyperbaric ropivacaine and bupivacaine for cesarean section.

BACKGROUND: Intrathecal anesthesia is commonly used for cesarean section. Bupivacaine and ropivacaine have all been used as intrathecal drugs. The minimum effective local anesthetic dose (MLAD) of intrathecal ropivacaine for non-obstetric patients has been reported. However, few data are available on the MLAD of hyperbaric ropivacaine for obstetric patients and the relative potency to bupivacaine has not been fully determined. In this study, we sought to determine the MLAD of intrathecal ropivacaine and bupivacaine for elective cesarean section and to define their relative potency ratio. METHODS: We enrolled forty parturients undergoing elective cesarean section under combined spinal-epidural anesthesia and randomized them to one of two groups to receive intrathecal 0.5% hyperbaric ropivacaine or bupivacaine. The initial dose was 10 mg, and was increased in increments of 1 mg, using the technique of up-down sequential allocation. Efficacy was accepted if adequate sensory dermatomal anesthesia to pin prick to T7 or higher was attained within 20 minutes after intrathecal injection, and required no supplementary epidural injection for procedure until at least 50 minutes after the intrathecal injection. RESULTS: The intrathecal MLAD was 9.45 mg (95%confidence interval (CI), 8.45 - 10.56 mg) for ropivacaine and 7.53 mg (95%CI, 7.00 - 8.10 mg) for bupivacaine. The relative potency ratio was 0.80 (95%CI, 0.74 - 0.85) for ropivacaine/bupivacaine when given intrathecally in cesarean section. CONCLUSION: Ropivacaine is 20% less potent than bupivacaine during intrathecal anesthesia for cesarean delivery.

[Epidural analgesia in latent phase of labor: effects on length of labor and mode of delivery].

OBJECTIVE: To compare the outcome of ropivacaine plus sufentanil for patient-controlled epidural analgesia between nulliparous women presenting in latent and active labor. METHODS: 360 nulliparous parturients were randomized according to cervix dilation. Latent group (cervix dilation < 3 cm) received 0.1% ropivacaine with 0.5 microg/ml sufentanil and active group (cervix dilation > or = 3 cm) receive 0.15% ropivacaine with 0.5 microg/ml sufentanil, both followed by an infusion of 0.1% ropivacaine with 0.5 microg/ml sufentanil through PCEA. The PCEA pump was programmed to infuse a 6 ml bolus with a lockout interval of 15-20 min. The following were recorded: (1) pain intensity evaluated using VAS (0-10), (2) motor block assessed using modified Bromage scale, (3) onset of analgesia after epidural injection, (4) fetal heart rate, (5) maternal vital signs, (6) apgar score, (7) labor process, (8) mode of delivery and (9) the total amount of analgesic consumed. RESULTS: Both groups provided good analgesia. Early administration of epidural analgesia did not prolong the duration of first and second stage of labor. However, group L had a significant higher caesarean section rate and a significant lower instrumental delivery rate than group A. The reasons of cesarean section in both groups were arrested active phase and fetal distress. The reasons of instrumental delivery in both groups were fetal distress. The neonates had good outcome in both groups. CONCLUSIONS: Compared with epidural analgesia in active phase of labor, early administration of epidural analgesia in latent phase did not prolong labor, however, the caesarean section rate was increased and instrumental delivery rate was decreased.

[Target-controlled infusions of remifentanil and propofol during laparoscopic cholecystectomy].

OBJECTIVE: To evaluate the clinical profile of target-controlled infusion-based anesthesia using remifentanil and propofol. METHODS: 16 ASA I-II patients undergoing elective laparoscopic cholecystectomy were enrolled. Remifentanil was set at 7 micrograms.L-1 as target and profol at 3 mg.L-1 throughout the whole procedure. The hemodynamics during induction of anesthesia and recovery profiles were recorded. Arterial blood samples for analysis of remifentanil were taken 15 min after infusion, 20 min after infusion and at time of emergence. RESULTS: After induction of anesthesia, systolic blood pressure (SBP) decreased from (144 +/- 27) mm Hg to (101 +/- 18) mm Hg (P < 0.05), mean blood pressure (MBP) decreased from (102 +/- 15) mm Hg to (69 +/- 13) mm Hg (P < 0.05) and heart rate (HR) decreased from (77 +/- 14) beats.min-1 to (63 +/- 12) beats.min-1 (P > 0.05). SBP, MBP and HR remained stable after intubation for 3 min. No patient showed haemodynamic stress to tracheal intubation. Times from stopping administration of anesthetics until full spontaneous respiration, eye opening, tracheal extubation, orientation and discharging from the postanesthetic care unit (PACU) were (12 +/- 6), (9 +/- 4), (13 +/- 6), (15 +/- 5) and (19 +/- 7) min respectively. Measured drug values of remifentanil were (4.6 +/- 9.5) microgram.L-1, (6.6 +/- 11.5) microgram.L-1, (1.2 +/- 8.7) microgram.L-1 respectively. CONCLUSION: Remifentanil/propofol TCI-based anesthesia achieved the optimal hemodynamic stability during anesthesia induction and maintenance, and better recovery profile from anesthesia. Measured drug values of remifentanil showed a considerable interindividual variation and more lower than the set target.