성인개심술 마취유도제로 사용한 Remifentanil의 혈역학적 효과 (The Hemodynamic Effects of Remifentanil as an Induction Agent in Cardiac Surgery)

서지정보

· 발행기관 : 대한마취통증의학회
· 수록지 정보 : Anesthesia and Pain Medicine / 2권 / 4호 / 219 ~ 223페이지
· 저자명 : 이윤경

초록

Background: Remifentanil may be advantageous during induction
of anesthesia in patient with heart disease because of rapid onset
and hemodynamic stability. Some study reported that remifentanil
showed complications such as profound bradycardia, severe hypotension
and rigidity. The purpose of this study is to investigate
the hemodynamic changes and side effects of remifentanil by using
the methods of bolus administration during induction of anesthesia
in cardiac surgery.
Methods: Fifty eight patients of ASA physical status 2~3 undergoing
cardiac surgery were enrolled into 3 groups. We administered
no remifentanil in Group A, 5μg/kg of remifentanil in Group B and
10μg/kg of remifentanil in Group C. After bolus administration of
remifentanil over 30 sec, we infused 0.2μg/kg/min of remifentanil
continuously. All group received continuous infusion of 100μg/
kg/min of propofol. After loss of consciousness, 0.15 mg/kg of
vecuronium was administered. After the Bispectral index (BIS) value
became lower than 60, intubation was done. Mean arterial pressure,
heart rate, the incidence of cough, jaw and chest wall rigidity, and
BIS value were measured initially and 1, 2, 3, 4, 5 minutes before
intubation and 1, 2, 3, 4, 5 minutes after intubation.
Results: Mean arterial pressures of group B and C were significantly
lower than those of group A (P ＜ 0.05). Heart rate was
similar among the groups. Group C showed a greater incidence of
jaw rigidity (77%) compared with group A (35%) and group B (35%)
(P ＜ 0.05). The incidence of chest wall rigidity (66%) in group C
was greater than group A (5%) and group B (15%) (P ＜ 0.05).
Conclusions: Remifentanil used as an induction agent (5μg/kg
or 10μg/kg) may cause hypotension and jaw, chest wall rigidity
with improper ventilation.

영어초록

Background: Remifentanil may be advantageous during induction
of anesthesia in patient with heart disease because of rapid onset
and hemodynamic stability. Some study reported that remifentanil
showed complications such as profound bradycardia, severe hypotension
and rigidity. The purpose of this study is to investigate
the hemodynamic changes and side effects of remifentanil by using
the methods of bolus administration during induction of anesthesia
in cardiac surgery.
Methods: Fifty eight patients of ASA physical status 2~3 undergoing
cardiac surgery were enrolled into 3 groups. We administered
no remifentanil in Group A, 5μg/kg of remifentanil in Group B and
10μg/kg of remifentanil in Group C. After bolus administration of
remifentanil over 30 sec, we infused 0.2μg/kg/min of remifentanil
continuously. All group received continuous infusion of 100μg/
kg/min of propofol. After loss of consciousness, 0.15 mg/kg of
vecuronium was administered. After the Bispectral index (BIS) value
became lower than 60, intubation was done. Mean arterial pressure,
heart rate, the incidence of cough, jaw and chest wall rigidity, and
BIS value were measured initially and 1, 2, 3, 4, 5 minutes before
intubation and 1, 2, 3, 4, 5 minutes after intubation.
Results: Mean arterial pressures of group B and C were significantly
lower than those of group A (P ＜ 0.05). Heart rate was
similar among the groups. Group C showed a greater incidence of
jaw rigidity (77%) compared with group A (35%) and group B (35%)
(P ＜ 0.05). The incidence of chest wall rigidity (66%) in group C
was greater than group A (5%) and group B (15%) (P ＜ 0.05).
Conclusions: Remifentanil used as an induction agent (5μg/kg
or 10μg/kg) may cause hypotension and jaw, chest wall rigidity
with improper ventilation.

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