Effect-site concentration of remifentanil for blunting hemodynamic responses to tracheal intubation using light wand during target controlled infusion-total intravenous anesthesia

BACKGROUND: Transillumination using a light wand is an alternative type of laryngoscope used for tracheal intubation. There is little information available on the effect-site concentration of remifentanil required to control hemodynamic changes induced by tracheal intubation using the transillumination method during total IV anesthesia. We therefore conducted this study to determine the effect-site concentration of remifentanil blunting hemodynamic responses after tracheal intubation in patients receiving propofol anesthesia. METHODS: We enrolled 26 healthy adult patients (ASA physical status I-II), aged 16-67 scheduled for surgery within 2 hours. All patients received a target-controlled infusion of 4 µg/ml propofol. The effect-site target-concentration of remifentanil of 5.0 ng/ml was chosen for the first patient. We used the Dixon's up-and-down sequential allocation method for determining the next remifentanil concentration. The time required for tracheal intubation was measured as the level of intubation stimulation. RESULTS: The average intubation time was 13.9 ± 9.1 seconds. From the Dixon's method, the EC(50) of remifentanil blunting the hemodynamic response to tracheal intubation was 2.94 ng/ml. CONCLUSIONS: This study shows that effect-site concentrations of remifentanil of 2.94 ng/ml is effective in blunting sympathetic responses to tracheal intubation in 50% of patients with normal airway anatomy when combined with a target controlled infusion of propofol (4 µg/ml).