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British Journal of Anaesthesia, Vol 80, Issue 4 509-511, Copyright © 1998 by The Board of Management and Trustees of the British Journal of Anaesthesia

SHORT COMMUNICATIONS

Remifentanil in combination with propofol for spontaneous ventilation anaesthesia

J. E. Peacock, J. B. Luntley, B. O'Connor, C. S. Reilly, T. W. Ogg, B. J. Watson and S. Shaikh
Department of Surgical and Anaesthetic Sciences, K floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2RX; Department of Anaesthetics, Day Surgery Unit, Addenbrooke's Hospital, Cambridge CB2 2QQ; Glaxo Wellcome Research and Development Ltd, Greenford Road, Greenford, Middlesex UB6 0HE

We have investigated the effect of four doses of remifentanil on the incidence of respiratory depression and somatic response at incision. Remifentanil was administered as a loading dose of 0.125, 0.25, 0.375 or 0.5 microgram kg-1 and at a maintenance infusion rate of 0.025, 0.05, 0.075 or 0.1 microgram kg-1 min-1, respectively, with an infusion of propofol 6 mg kg-1 h-1. Responses occurred in 88% of patients with remifentanil 0.025 microgram kg-1 min-1 compared with 30-40% in the other groups. Respiratory depression after incision increased from 6% with remifentanil 0.025 microgram kg-1 min-1 to 73% with 0.1 microgram kg-1 min-1. Increases in propofol infusion rate to 7.2-8.4 mg kg-1 h-1 produced adequate maintenance of anaesthesia. Reductions in remifentanil doses to 0.025-0.05 microgram kg-1 min-1 resulted in adequate respiration at the end of surgery in 88% of patients. Maintenance infusions of the two drugs for spontaneous ventilation are likely to be in these ranges. However, the ideal loading doses and infusion rates for induction remain to be established.
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