Vol 66: Optimal effect-site concentration of remifentanil when combined with dexmedetomidine in patients undergoing cystoscopy.Report as inadecuate



 Vol 66: Optimal effect-site concentration of remifentanil when combined with dexmedetomidine in patients undergoing cystoscopy.


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This article is from Korean Journal of Anesthesiology, volume 66.AbstractBackground: Cystoscopic procedure is a very common practice in the field of urology due to its ability to survey the bladder for a variety of indications. However, patients who undergo cystoscopy feel intense pain and discomfort. This study investigated the half maximal effective concentration EC50 of remifentanil in preventing cystoscope insertion pain under sedation using dexmedetomidine. Methods: The study was prospectively conducted on 18 male patients, aged 18 to 65. Remifentail infusion was initiated together with dexmedetomidine, and started at a dose of 2.4 ng-ml on the first patient. The effect-site concentration Ce of remifentanil for each subsequent patient was determined by the previous patients response using Dixons up-and-down method with an interval of 0.3 ng-ml. Patients received a loading dose of 1.0 µg-kg dexmedetomidine over 10 minutes, followed by a maintenance dose of 0.6 µg-kg-hr. After the patients OAA-S score Observers Assessment of Alertness-Sedation scale reached 3-4, and the Ce of remifentanil reached target concentration, the urologist was allowed to insert the cystoscope and the pain responses were observed. Results: The effect-site concentration of remifentanil required to prevent cystoscope insertion pain in 50% of patients under sedation using dexmedetomidine was 1.30 ± 0.12 ng-ml by Dixons up-and-down method. The logistic regression curve of the probability of response showed that the EC50 and EC95 values 95% confidence limits of remifentanil were 1.33 ng-ml 1.12-1.52 ng-ml and 1.58 ng-ml 1.44-2.48 ng-ml, respectively. Conclusions: Cystoscopic procedure can be carried out successfully without any pain or adverse effects by optimal remifentanil effect-site concentration EC50, 1.33 ng-ml; EC95, 1.58 ng- ml combined with sedation using dexmedetomidine.



Author: Heo, Bongha; Kim, Minsun; Lee, Hyunjung; Park, Sanghee; Jeong, Seongwook

Source: https://archive.org/







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