British Journal of Anaesthesia, Vol 76, Issue 6 795-801, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
I. Crabb, C. Thornton, K. M. Konieczko, A. Chan, R. Aquilina, N. Frazer, C. J. Dore and DEF. Newton
We studied 60 patients during stable isoflurane anaesthesia (0.4 MAC) after
premedication with temazepam. Patients were allocated randomly to one of
three dose regimens of remifentanil: 1 microgram kg-1 i.v. over 1 min and
an infusion of 0.2 microgram kg-1 min-1 (low dose); 2.5 micrograms kg-1 and
0.5 microgram kg-1 min-1 (medium dose); and 5 micrograms kg-1 and 1
microgram kg-1 min-1 (high dose). The auditory (AER) and median nerve
somatosensory (SER) responses were elicited throughout, and recorded before
and after tracheal intubation, and surgical incision, together with
systolic and diastolic arterial pressure and heart rate. Venous blood
concentrations of remifentanil were measured at the above times. After
administration of remifentanil, Pa and Nb amplitudes of the AER increased
at the low dose, remained constant at the medium dose and decreased at the
high dose. This dose- related effect was linear and significant (P = 0.012,
P = 0.05). Pa amplitude correlated inversely with remifentanil blood
concentrations before and after intubation and incision (P = 0.002, P <
0.001, P < 0.001 and P < 0.001). In the SER, P15-N20 amplitudes
decreased after administration of remifentanil (P < 0.001), whereas
P25-N35 and N35-P45 amplitudes increased at all dose concentrations (P <
0.001 and P < 0.001). After intubation, P15-N20 and N35-P45 amplitudes
increased at the low dose, did not change at the medium dose and decreased
at the high dose (P = 0.001, P = 0.027). After remifentanil, systolic and
diastolic arterial pressure and heart rate decreased in a linearly dose-
related manner (P = 0.033, P < 0.001, P < 0.001). At all doses the
three variables increased after intubation (P = 0.001, P < 0.001, P <
0.01), and systolic and diastolic arterial pressure increased after
incision (P = 0.027, P = 0.039).
CLINICAL INVESTIGATIONS
Remifentanil reduces auditory and somatosensory evoked responses during isoflurane anaesthesia in a dose-dependent manner
Department of Anaesthesia, Northwick Park Hospital, Academic Department of Anaesthesia, St Mary's Hospital Medical School, and Northwick Park Institute for Medical Research, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ
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