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Background: The present study was undertaken to determine the effect-site concentration of remifentanil for blunting hemodynamic responses to tracheal intubation during total intravenous anesthesia (TIVA) using propofol. Methods: In this prospective, randomized, double-blind study, a total of 126 patients, aged 18-60 (ASA I or II), having undergone elective surgery under TIVA using propofol were investigated. Anesthesia was induced using propofol (target effect-site concentration 4μg/ml) and rocuronium (0.9 mg/kg). Remifentanil was infused at target effect-site concentrations of 0, 2, 4, 6 ng/ml: groups R1, R2, R3 and R4, respectively. The systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and heart rate (HR) were measured pre-induction, and before and after tracheal intubation. Results: After intubation, the SAP, DAP and HR increased significantly (P  0.05) in all groups compared to the pre-intubation values. Compared with pre-induction values, the SAP and DAP in groups R1 and R2 increased significantly after intubation (P  0.05), but those in group R3 remained constant until 1 min after intubation. The SAP and DAP in group 4 however, decreased significantly (P  0.05) for 3 min after intubation. The HR increased significantly after intubation in groups R1, R2 and R3 compared to the values before intubation (P  0.05), but that in group R4 being remained constant. Conclusions: We suggest that the optimal target effect-site concentrations of remifentanil for blunting hemodynamic responses to tracheal intubation were 4 or 6 ng/ml during TIVA using propofol.

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Evaluation of Effect-site Concentration of Remifentanil for Blunting Hemodynamic Responses to Endotracheal Intubation during Total Intravenous Anesthesia using Propofol