Anesthesia
Conditions
Brief summary
The investigators therefore hypothesized that remifentanil could prolong the onset time of rocuronium, and evaluated the effect of remifentanil on the hemodynamic profiles (arterial pressure and heart rate) during the anesthetic induction sequence.
Detailed description
It has been reported that co-administration of ephedrine reduced the onset time of neuromuscular block of rocuronium (1-3). It also provided an improved condition for the rapid tracheal intubation (2,4). This beneficial effect was attributed to the increased cardiac output and tissue perfusion to muscle, and therefore, a more rapid delivery of rocuronium to the neuromuscular junction was achieved (4-5). If so, any drugs which decrease cardiac output consequently can prolong the onset time of rocuronium. Remifentanil is the first ultra-short acting opioid with a rapid onset. During the total intravenous anesthesia (TIVA) with propofol and remifentanil, prior administration of remifentanil could reduce the propofol infusion pain without other significant complications (6). However, remifentanil can decrease the arterial pressure and heart rate (7-8), so that it is likely to decrease the onset time of rocuronium for the opposite principle that ephedrine increases it. The investigators therefore hypothesized that remifentanil could prolong the onset time of rocuronium, and evaluated the effect of remifentanil on the hemodynamic profiles (arterial pressure and heart rate) during the anesthetic induction sequence.
Interventions
DRUGthe order of drug administration
In group R, remifentanil was infused first before administrating propofol and rocuronium and in group P, it was administered last after the rocuronium injection. In other words, the order of drug infusion in each group is remifentanil-propofol-rocuronium in group R and propofol-rocuronium-remifentanil in group P, respectively.
Sponsors
Seoul National University Bundang Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologist physical status I or II * Aged 20-65 yr * Elective surgery under general anesthesia with total intravenous anesthesia * 8.5 kg/m2 \< body mass index (BMI) \< 25 kg/m2
Exclusion criteria
* BMI \> 25 kg/m2 or \< 18.5 kg/m2 * Any cardiovascular or neuromuscular disease * Intake of drugs known to interact with the neuromuscular junction * Patients wit risk of pulmonary aspiration * Anticipated difficult airway * history of known allergy to rocuronium
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the onset time of rocuronium | 3 minutes [after injection of rocuronium when general anesthesia is induced.] | Onset time of rocuronium was defined as the time from the end of its injection to the 95% depression of single twitch response, and it was measured by an anaesthesiologist, unaware of the group allocation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| mean arterial pressure (MAP) | 15 minutes [4 times; during the induction of general anesthesia as described below.] | 1. before induction (baseline): When a patient enter the operating room, 2. at rocuronium administration: immediately before injecting rocuronium, 3. before tracheal intubation: immediately before intubation, 4. after tracheal intubation: immediately after intubation. |
| heart rate (HR) | 15 minutes [4 times; during the induction of general anesthesia as described below.] | 1. before induction (baseline): When a patient enter the operating room, 2. at rocuronium administration: immediately before injecting rocuronium, 3. before tracheal intubation: immediately before intubation, 4. after tracheal intubation: immediately after intubation. |
| cardiac output | 15 minutes [4 times; during the induction of general anesthesia as described below.] | 1. before induction (baseline): When a patient enter the operating room, 2. at rocuronium administration: immediately before injecting rocuronium, 3. before tracheal intubation: immediately before intubation, 4. after tracheal intubation: immediately after intubation. |
| pain from the propofol infusion | 1 minute [at the time when propofol is administered.] | When propofol is administered for the induction of anesthesia, we investigate the pain by propofol. |
| cough or chest wall rigidity from the remifentanil infusion | 1 minute [at the time when remifentanil is infused.] | when remifentanil is infused, the cough or chest wall rigidity is checked. |
Countries
South Korea
Outcome results
None listed