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

Heo B, Kim M, Lee H, Park S, Jeong S - Korean J Anesthesiol (2014)

Bottom Line: The effect-site concentration (Ce) of remifentanil for each subsequent patient was determined by the previous patient's response using Dixon's up-and-down method with an interval of 0.3 ng/ml.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 Dixon's up-and-down method.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesioloy and Pain Medicine, Chonnam National University Hospital, Gwangju, Korea.

ABSTRACT

Background: 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 patient's response using Dixon's 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 patient's OAA/S score (Observer's 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 Dixon's 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.

No MeSH data available.


Related in: MedlinePlus

Responses of 18 consecutive patients in whom cystoscopy was performed and the effect-site concentrations of remifentanil. An arrow represents the mean remifentanil concentration when crossing from a success (white circle) to a failure (black circle) for preventing cystoscope insertion pain. The average of these concentrations (EC50) was 1.30 ± 0.12 ng/ml.
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Figure 1: Responses of 18 consecutive patients in whom cystoscopy was performed and the effect-site concentrations of remifentanil. An arrow represents the mean remifentanil concentration when crossing from a success (white circle) to a failure (black circle) for preventing cystoscope insertion pain. The average of these concentrations (EC50) was 1.30 ± 0.12 ng/ml.

Mentions: The sequences of consecutive response and nonresponse are shown in Fig. 1.


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

Heo B, Kim M, Lee H, Park S, Jeong S - Korean J Anesthesiol (2014)

Responses of 18 consecutive patients in whom cystoscopy was performed and the effect-site concentrations of remifentanil. An arrow represents the mean remifentanil concentration when crossing from a success (white circle) to a failure (black circle) for preventing cystoscope insertion pain. The average of these concentrations (EC50) was 1.30 ± 0.12 ng/ml.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927000&req=5

Figure 1: Responses of 18 consecutive patients in whom cystoscopy was performed and the effect-site concentrations of remifentanil. An arrow represents the mean remifentanil concentration when crossing from a success (white circle) to a failure (black circle) for preventing cystoscope insertion pain. The average of these concentrations (EC50) was 1.30 ± 0.12 ng/ml.
Mentions: The sequences of consecutive response and nonresponse are shown in Fig. 1.

Bottom Line: The effect-site concentration (Ce) of remifentanil for each subsequent patient was determined by the previous patient's response using Dixon's up-and-down method with an interval of 0.3 ng/ml.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 Dixon's up-and-down method.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesioloy and Pain Medicine, Chonnam National University Hospital, Gwangju, Korea.

ABSTRACT

Background: 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 patient's response using Dixon's 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 patient's OAA/S score (Observer's 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 Dixon's 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.

No MeSH data available.


Related in: MedlinePlus