• Journal of Veterinary Clinics
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• v.30 no.6
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• pp.428-434
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• 2013

The combinations of alfaxalone and remifentanil constant rate infusion in dogs premedicated with xylazine or acepromazine were compared. Ten beagle dogs were used and assigned randomly into 2 groups (5 dogs for each group). In group AAR, dogs were premedicated with 0.02 mg/kg of intravenous acepromazine at 15 min before induction. In group XAR, 1.1 mg/kg of intravenous xylazine was premedicated at 5 min before induction. In both groups, anesthesia was induced with alfaxalone and maintained with the combination of alfaxalone (6 mg/kg/hr, IV) and remifentanil (0.05 ${\mu}g/kg/min$, IV). bispectral index score was decreased after induction of anesthesia compared with baseline in both groups and no steep increase was observed during anesthesia. Bispectral index scores and electromyographs in group XAR were significant decreased compared with those in group AAR. Although the pulmonary depression in group XAR and tachycardia in group AAR should be considered to use these regimes, the combinations of alfaxalone and remifentanil constant rate infusion in dogs premedicated with xylazine or acepromazine provided adequate analgesia and anesthesia in this study.

• Journal of Veterinary Clinics
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• v.29 no.6
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• pp.447-454
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• 2012

The objective of this study was to determine the effect of propofol and remifentanil combination on hemodynamics and intraocular pressure (IOP), and to compare with those of isoflurane in beagle dogs. Fourteen clinically healthy beagle dogs were divided randomly into 2 groups and each group was consisted with 7 dogs. Anesthetic agents were propofol (0.2 mg/kg/min) plus remifentanil ($0.5{\mu}g/kg/min$, 1% solution in standard saline) in one group (group PRP) and 3% isoflurane in the other group (group ISF). Anesthesia was maintained for 90 min in the both groups. IOP, blood pressure, heart rate and blood gas values (pH, $PaCO_2$, $PaO_2$, $SaO_2$, $tCO_2$, ${HCO_3}^-$) were recorded at 5, 10, 15, 30, 45, 60, 75 and 90 min in the both groups. IOP values in both eyes were significantly decreased in group PRP compared with those in group ISF. but there were no significant differences between two eyes in each group. Systolic, diastolic and mean blood pressures were significantly decreased in group PRP within the normal range. There were no differences between groups in all blood gas parameters. In this study, propofol and remifentanil combination could provide stable IOP and blood pressure compared with isoflurane.

• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.3
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• pp.157-165
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• 2014

Background: Incisional site of surgical operation become transient ischemic state and then occur reoxygenation due to vasodilatation by inflammatory reaction, the productive reactive oxygen species (ROS) give rise to many physiologic results. Apoptosis have major role on elimination of inflammatory cell and formation of granulation tissue in normal wound healing process. Remifentanil can prevent the inflammatory response and can suppress inducible nitric oxide synthase expression in a septic mouse model. After cardiopulmonary bypass for coronary artery surgery, remifentanil can also inhibit the release of biomarkers of myocardial damage. Here we investigated whether remifentanil pretreatment has cellular protective effect against hypoxia-reoxygenation in HaCaT human keratinocytes, if so, the role of apoptosis and autophagy on this phenomenon. Methods: The HaCaT human keratinocytes were exposed to various concentrations of remifentanil (0.01, 0.05, 0.1, 0.5 and 1 ng/ml) for 2 h before hypoxia (RPC/HR group). These cells were cultured under 1% oxygen tension for 24h at $37^{\circ}C$. After hypoxia, to simulate reoxygenation and recovery, the cells were reoxygenated for 12 h at $37^{\circ}C$. 3-MA/RPC/HR group was treated 3-methyladenine (3-MA), autophagy inhibitor for 1h before remifentanil treatment. Cell viability was measured using a quantitative colorimetric assay with thiazolyl blue tetrazoliumbromide (MTT, amresco), showing the mitochondrial activity of living cells. To investigate whether the occurrence of autophagy and apoptosis, we used fluorescence microscopy and Western blot analysis. Results: The viability against hypoxia-reoxygenation injury in remifentanil preconditioning keratinocytes were increased, and these cells were showed stimulated expression of autophagy 3-MA suppressed the induction of autophagy effectively and the protective effects on apoptosis. Atg5, Beclin-1, LC3-II and p62 were elevated in RPC/HR group. But they were decreased when autophagy was suppressed by 3-MA. Conclusions: Remifentanil preconditioning showed the protective effect in human keratinocytes, and we concluded that autophagy may take the major role in the recovery of wound from hypoxia-reoxygenation injury. We suggest that further research is needed about the cell protective effects of autophagy.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.4
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• pp.195-202
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• 2020

Background: Nasotracheal intubation is the most commonly used method to secure the field of view when performing surgery on the oral cavity or neck. Like orotracheal intubation, nasotracheal intubation uses a laryngoscope. Hemodynamic change occurs due to the stimulation of the sympathetic nervous system. Recently, video laryngoscope with a camera attached to the end of the direct laryngoscope blade has been used to minimize this change. In this study, we investigated the optimal effect-site concentration (Ce) of remifentanil for minimizing hemodynamic responses during nasotracheal intubation with a video laryngoscope. Methods: Twenty-one patients, aged between 19 and 60 years old, scheduled for elective surgery were included in this study. Anesthesia was induced by slowly injecting propofol. At the same time, remifentanil infusion was initiated at 3.0 ng/ml via target-controlled infusion (TCI). When remifentanil attained the preset Ce, nasotracheal intubation was performed using a video laryngoscope. The patient's blood pressure and heart rate were checked pre-induction, right before and after intubation, and 1 min after intubation. Hemodynamic stability was defined as an increase in systolic blood pressure and heart rate by 20% before and after nasotracheal intubation. The response of each patient determined the Ce of remifentanil for the next patient at an interval of 0.3 ng/ml. Results: The Ce of remifentanil administered ranged from 2.4 to 3.6 ng/ml for the patients evaluated. The estimated optimal effective effect-site concentrations of remifentanil were 3.22 and 4.25 ng/ml, that were associated with a 50% and 95% probability of maintaining hemodynamic stability, respectively. Conclusion: Nasotracheal intubation using a video laryngoscope can be successfully performed in a hemodynamically stable state by using the optimal remifentanil effect-site concentration (Ce₅₀, 3.22 ng/ml; Ce₉₅, 4.25 ng/ml).

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.2
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• pp.209-213
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• 2010

Anxiety and fear is two main factors that keep patients from going to dental clinic. Especially, patients may feel implants operations are more traumatic. Intravenous conscious sedation for dental treatment can make patient comfortable and relaxable. Midazolam is more popular for sedation for dental treatment, but target-controlled infusion (TCI) of propofol and remifentanil is gaining wide popularity. A 54-year-old female patient who had severe dental phobia was referred to our dental hospital. She had past history of 2 times of hyperventilation and syncope during dental treatment. The patient showed a lot of dental anxiety and fear to dental treatments and stress reduction protocol was needed. We administered intravenous conscious sedation using target controlled infusion system with remifentanil and propofol. During sedation, we monitored the status of consciousness with bispectral index and vital signs. Dental treatment could be finished successfully without any problems.

• Journal of Yeungnam Medical Science
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• v.40 no.3
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• pp.247-251
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• 2023

Background: While some evidence indicates that propofol-based anesthesia has less postoperative pain than sevoflurane-based anesthesia, these results are controversial. We compared acute postoperative pain intensity and opioid consumption after total shoulder arthroplasty between propofol-remifentanil (PR) and sevoflurane-remifentanil (SR) anesthesia. Methods: Among 48 patients undergoing shoulder arthroscopic surgery anesthetized with PR or SR, postoperative pain intensity was assessed at 30 minutes and at 2, 6, 12, and 24 hours. The total patient-controlled analgesia volume and number of patients requiring rescue analgesics were assessed. Results: No significant difference in postoperative pain intensity was observed between the two groups. Postoperative opioid consumption and analgesic requirements were also comparable in the first 24 hours after surgery. Conclusion: PR and SR anesthesia for shoulder arthroscopic surgery provide comparable postoperative analgesia results.

• The Korean Journal of Pain
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• v.21 no.1
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• pp.44-50
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• 2008

Background: The use of regional local anesthetics or opioids during laparoscopic cholecystectomy (LC), in combination with general anesthesia, has been investigated in several interventional studies. Methods: We studied a total of 240 (n = 60, each) patients who were undergoing LC, and they received local infiltration and intraperitoneal instillation with normal saline or 0.25% levobupivacaine 60 ml. Group R (S) received infiltration of normal saline 20 ml before incision and at the end of surgery and then 40 ml intraperitoneal instillation after removal of the gall bladder under remifentanil-based anesthesia. Group R (L) received 0.25% levobupivacaine instead of normal saline in the same method like group R (S). Group S (S) received the same method as group R (S) under sevoflurane based anesthesia in place of remifentanil. Group S (L) received 0.25% levobupivacaine instead of normal saline with the same method as group S (S). Pain was assessed on a visual analog scale at 1, 6, 12 and 24 hours after operation. Results: The pain intensity of Group R (L) was significantly lower than that of group R (S), and the the incisional pain of group S (L) was significantly lower than that of group S (S) in the first six hours. The time delay to first operative analgesics in group R (S) and group S (S) was significantly shorter than that of group R (L) and group S (L). Conclusions: Infiltration and instillation of levobupivacaine reduced the postoperative pain and remifentanil did not increase the pain severity and opioid requirement when performing the LC.

• Women's Health Nursing
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• v.21 no.1
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• pp.1-10
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• 2015

Purpose: The purpose of this study was to compare desflurane anesthesia with desflurane-remifentanil anesthesia by measuring postoperative pain, nausea and vomiting after gynecologic laparoscopic surgery. Methods: Data were collected using a random double blind method. The experimental group treated with desflurane-remifentanil anesthesia had a total of 25 patients. The control group had 20 patients who were treated with desflurane anesthesia. Pain (VAS), pushing PCA button, nausea and vomiting (VAS) were assessed at PACU (Post Anesthesia Care Unit) arrival, 10 min, 20 min, 30 min in PACU and 2 hrs, 6 hrs, 24 hrs, 48 hrs in ward. INVR was assessed at 24 hrs. Extra analgesics and extra antiemetics were measured in PACU and the ward. Data were analyzed using t-test and repeated measure using ANOVA. Results: The experimental group presented with more postoperative pain (F=7.55, p<.001) than the control group. The experimental group took more extra analgesics in PACU and pressed the PCA button more often for 6 hours. The experimental group complained more postoperative nausea (F=2.11, p=.043) than the control group and took extra antiemetics during postoperative period of 24 hours. Conclusion: We conclude that desflurane-remifentanil anesthesia needs better management than desflurane anesthesia due to increased pain, nausea & vomiting after gynecologic laparoscopic surgery.

• Journal of Korean Neurosurgical Society
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• v.48 no.5
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• pp.429-433
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• 2010

Objective : This prospective study evaluated the use of continuous sedation using propofol and remifentanil when carpal tunnel release (CTR) was performed under local anesthesia. Methods : We sedated 60 patients undergoing CTR using local anesthesia with remifentanil at loading and continuous doses of $0.5\;{\mu}g\;kg^{-1}$ and $0.05\;{\mu}g\;kg^{-1}min^{-1}$, respectively, and propofol, using a target controlled infusion (TCI) pump set to a target of $2\;{\mu}g\;mL^{-1}$ (group A), or with the same drug doses except that the continuous remifentanil dose was $0.07\;{\mu}g\;kg^{-1}min^{-1}$ (group B) or $0.1\;{\mu}g\;kg^{-1}min^{-1}$ (group C). Results : In group B, the levels of pain when local anesthetics were administered (p = 0.001), intraoperative pain (p < 0.001) and anxiety (p = 0.001) were significantly lower than those of group A. Furthermore, the incidence of adverse events, including desaturation (p < 0.001) and vomiting (p = 0.043), was significantly lower in group B than in group C. Conclusion : Continuous sedation using an appropriate dose of remifentanil and propofol can be used as safe, efficacious ambulatory anesthesia in cases of CTR under local anesthesia, performed using only 2 mL of local anesthetic, with a high degree of patient satisfaction.

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.2
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• pp.159-165
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• 2010

배경: 매복지치의 수술적 발치 시 propofol과 remifentanil을 이용한 목표조절농도주입(Target controlled infusion) 의식하 정주진정법의 적절한 주입농도를 제시하고 그 안전성을 평가하고자 하였다. 방법: 매복지치의 수술적 발치가 예정된 미국마취학회 신체 등급 분류 1, 2에 속하는 15-65세, 142명(여 83명, 남 59명)의 환자를 대상으로 소급 연구하였다. 환자는 수술 전 목표조절농도주입법을 이용한 의식하 진정법 사용에 관한 동의서를 작성하였다. 정맥내 삽관을 시행하고 수액을 공급을 시작하고, 4-5 L/min의 산소를 비관을 통해서 공급하였다. Propofol과 remifentanil의 초기 목표 혈중농도는 각각 $0.5\;{\mu}g/ml$와 1.0 ng/ml로 정하였다. 수술 중, 환자의 불안 통증 정도에 따라 목표농도를 조절하였으며 최저 농도와 최대 농도, 평균 농도, 주입된 총 용량을 기록하였다. 또한 수축기혈압과 맥박 수, 산소포화도, 호기 말 이산화탄소량을 수술 시작 전, 수술 중 5분 간격으로 확인하고 기록하였다. 모든 측정치는 평균 $\pm$ 표준편차나 환자의 수, 초기 측정치에서의 백분율 편차로 표시하였다. 결과: 수술 동안의 목표 혈중농도의 평균은 propofol은 $0.54{\pm}0.11\;{\mu}g/ml$이고, remifentanil은 $1.11{\pm}0.30\;ng/ml$였다. 수술 중 조절된 최대농도는 propofol은 $0.6{\pm}0.23\;{\mu}g/ml$이고, remifentanil은 $1.3{\pm}0.63\;ng/ml$였다. 이는 의식하 진정에 해당되는 범의의 농도라고 할 수 있겠다. 진정동안 환자의 언어적 의사소통은 유지 되었으며 산소 포화도는 4-5 L/min 의 산소 보충 하에 98%이상으로 유지되었다. 수축기 혈압과 맥박은 대부분의 환자에서 정상변위범위(${\pm}20%$)내에서 유지되었다. 결론: 본 연구는 목표조절 농도주입 의식하 진정에서 사용된 농도(propofol $0.5\;{\mu}g/ml$, remifentanil 1.0 ng/ml)는 안전하게 의식하 진정을 가능한 것을 보여준다. 이는 치과 치료 시 목표조절농도 주입의식하 진정법에서 적절한 목표농도를 제시한다.