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British Journal of Anaesthesia, 2001, Vol. 86, No. 4 523-527
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia

Effects of fentanyl, alfentanil, remifentanil and sufentanil on loss of consciousness and bispectral index during propofol induction of anaesthesia

C. Lysakowski, L. Dumont, M. Pellégrini, F. Clergue and E. Tassonyi

Division of Anaesthesiology, Geneva University Hospitals, CH-1211 Geneva 14, Switzerland*Corresponding author

The bispectral index (BIS) and a sedation score were used to determine and compare the effect of propofol in the presence of fentanyl, alfentanil, remifentanil and sufentanil. Seventy-five non-premedicated patients were assigned randomly into five groups (15 in each) to receive fentanyl, alfentanil, remifentanil, sufentanil or placebo. Opioids were administered using a target-controlled infusion device, to obtain the following predicted effect-site concentrations: fentanyl, 1.5 ng ml–1; alfentanil, 100 ng ml–1; remifentanil, 6 ng ml–1; and sufentanil, 0.2 ng ml–1. After this, a target-controlled infusion of propofol (Diprifusor) was started to increase concentration gradually, to achieve predicted effect-site concentrations of 1, 2, and 4 µg ml–1. At baseline and at each successive target effect-site concentration of propofol, the BIS, sedation score and haemodynamic variables were recorded. At the moment of loss of consciousness (LOC), the BIS and the effect-site concentration of propofol were noted. The relationship between propofol effect-site concentration and BIS was preserved with or without opioids. In the presence of an opioid, LOC occurred at a lower effect-site concentration of propofol and at a higher BIS50 (i.e. the BIS value associated with 50% probability of LOC), compared with placebo. Although clinically the hypnotic effect of propofol is enhanced by analgesic concentrations of µ-agonist opioids, the BIS does not show this increased hypnotic effect.

Br J Anaesth 2001; 86: 523–7


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