The Effect of Remifentanil with Sevoflurane in Subtotal Gastrectomy Patients with Patient Controlled Epidural Analgesia / 대한마취과학회지

BACKGROUND: Remifentanil is an ultra-short acting opioid, and its use has been known to be related to acute opioid withdrawal or tolerance. This study was performed to compare the hemodynamic response, recovery characteristics, and postoperative pain response after sevoflurane-remifentanil or sevoflurane anesthesia in subtotal gastrectomy patients. METHODS: Sixty patients scheduled for gastrectomy were randomly allocated into two groups. Thoracic epidural catheterization was performed before anesthesia. Anesthesia was maintained with sevoflurane-remifentanil (SR group) or sevoflurane (SN group). We compared hemodynamic variables during surgery and recovery, the pain and sedation score during recovery, and the pain score and analgesic requirements during the postoperative period. RESULTS: Intraoperative blood pressure and heart rates in the SR group were lower than in the SN group. There was no significant difference in extubation time and recovery time between patients in the two groups. The patients in the SN group showed more prompt recovery at 15 minutes after extubation. The VAS scores and analgesic demand of the SR group were greater than in the SN group. CONCLUSIONS: Intraoperative use of remifentanil with sevoflurane may be related to increased postoperative pain.

The Effects of Midazolam or Propofol Combined with Remifentanil Infusion for Central Venous Catheterization in Children / 대한마취과학회지

BACKGROUND: Midazolam or propofol has been used for the procedural sedation in children. However, the combined use of remifentanil have not been widely investigated. The purpose of this study was to evaluate the effectiveness and safety of remifentanil infusion with intravenous anesthetics during the central venous catheterization in children. METHODS: After institutional review board approval and written informed consent from patients' parent, 20 children planned central venous catheterization for chemotherapy were randomly assigned into two groups. All patients were infused with remifentanil 0.1microng/kg/min. In M group, 0.3 mg/kg of midazolam bolus was injected and 0.1 mg/kg bolus were injected intermittently if the sedation was inadequate. In P group, 1.0 mg/kg of propofol bolus and 150microng/kg/min were infused. 0.5 mg/kg of propofol was given intermittently if the sedation was inadequate. Hemodynamic variables, end-tidal CO2 (EtCO2), bispectral index score (BIS) were monitored throughout the procedure. RESULTS: There were no significant differences in hemodynamic variables, sedation and recovery times. Oxygen saturation (SpO2) in P group was significantly lower than that of M group at 15 min after the start of infusion. EtCO2 in P group was significantly higher than that of M group at 10 min after the start of infusion. Hypoxemia (SpO2< 90%) were occurred in three patients of P group. There was no significant difference in BIS among the groups. CONCLUSIONS: The combined infusion of remifentanil 0.1microng/kg/min with midazolam provided successful sedation without airway assistance during the central venous catheterization in children.