The EC50 of remifentanil to minimize the cardiovascular changes during head holder pinning in neurosurgery

Wang Seok Do; Tae Kyun Kim; Hae Kyu Kim; Cheul Hong Kim
October 2012
Korean Journal of Anesthesiology;Oct2012, Vol. 63 Issue 4, p327
Academic Journal
Background: During neuroanesthesia, head holder pinning commonly results in sympathetic stimulation manifested by hemodynamic changes, such as increased heart rate and arterial blood pressure. Remifentanil has been used successfully to control acute autonomic responses during neurosurgical procedures. The objective of this study was to determine effect-site concentration of remifentanil for suppressing the hemodynamic response to head holder pinning with the probability of 50% (EC50). Methods: Forty-one ASA physical status I or II patients, between the ages of 20-70, who were scheduled for neurosurgery were recruited into this study. After arrival in the operating room, standard monitoring was applied throughout the study, which included a bispectral index monitor. Both propofol and remifentanil were administered by Target-control infusion device. The Dixon "up-and-down" sequential allocation method was used to determine the EC50 of remifentanil. Results: The EC50 of remifentanil was 2.19 ± 0.76 ng/ml by the turning point estimate (TPE). In probit analysis, EC50 was 2.42 ng/ml (95% CI : -0.62-4.66) and EC95 was 5.70 ng/ml (95% CI : 4.02-67.53). The EC50 estimator comes from isotonic regression is 2.90 ng/ml (95% CI : 1.78-3.65). The EC95 estimator comes from isotonic regression is 4.28 ng/ml (95% CI : 3.85-4.41). Conclusions: This study showed that EC50 of remifentanil was 2.19 ± 0.76 ng/ml by TPE. EC50 was 2.42 ng/ml (95% CI -0.62-4.66) in probit analysis, as back up analysis. The EC50 estimator comes from isotonic regression is 2.90 ng/ml (95% CI : 1.78-3.65).


Related Articles

  • Cardiovascular Responses Induced by Obstructive Apnea Are Enhanced in Hypertensive Rats Due to Enhanced Chemoreceptor Responsivity. Angheben, Juliana M. M.; Schoorlemmer, Guus H. M.; Rossi, Marcio V.; Silva, Thiago A.; Cravo, Sergio L. // PLoS ONE;Jan2014, Vol. 9 Issue 1, p1 

    Spontaneously hypertensive rats (SHR), like patients with sleep apnea, have hypertension, increased sympathetic activity, and increased chemoreceptor drive. We investigated the role of carotid chemoreceptors in cardiovascular responses induced by obstructive apnea in awake SHR. A tracheal...

  • Effect of magnitopuncture on sympathetic and parasympathetic nerve activities in healthy drivers — assessment by power spectrum analysis of heart rate variability. Li, Zengyong; Jiao, Kun; Chen, Ming; Wang, Chengtao // European Journal of Applied Physiology;Jan2003, Vol. 88 Issue 4/5, p404 

    The object of this study was to assess the effects of magnitopuncture applied to Dazhui (DU14) point and Neiguan (PC6) points on sympathetic and parasympathetic nerve activities by power spectrum analysis of heart rate variability in healthy drivers during simulated driving. Using power spectrum...

  • Vagal Nerve Stimulation Therapy: What Is Being Stimulated? Kember, Guy; Ardell, Jeffrey L.; Armour, John A.; Zamir, Mair // PLoS ONE;Dec2014, Vol. 9 Issue 12, p1 

    Vagal nerve stimulation in cardiac therapy involves delivering electrical current to the vagal sympathetic complex in patients experiencing heart failure. The therapy has shown promise but the mechanisms by which any benefit accrues is not understood. In this paper we model the response to...

  • The implication of protein malnutrition on cardiovascular control systems in rats. Silva, Fernanda C.; de Menezes, Rodrigo C.; Chianca Jr., Deoclécio A.; Colombari, Eduardo; Cruz, Josiane Campos // Frontiers in Physiology;Sep2015, p1 

    The malnutrition in early life is associated with metabolic changes and cardiovascular impairment in adulthood. Deficient protein intake-mediated hypertension has been observed in clinical and experimental studies. In rats, protein malnutrition also increases the blood pressure and enhances...

  • BP regulation VI: elevated sympathetic outflow with human aging: hypertensive or homeostatic? Taylor, J.; Tan, Can // European Journal of Applied Physiology;Mar2014, Vol. 114 Issue 3, p511 

    Though conventional wisdom suggests that a rise in blood pressure is a reality of advancing age, in fact, it appears that progressive elevation in sympathetic activity, not necessarily accompanied by increased blood pressure, is intrinsic to cardiovascular aging in humans. The mechanism behind...

  • Spectral analysis of heart rate variability in evaluation of sympathetic function in elderly... Luutonen, Sinikka; Antila, Kari // Age & Ageing;Nov94, Vol. 23 Issue 6, p473 

    Examines the value of spectral analysis of heart rate variability in the evaluation of sympathetic function in elderly people in Finland. Use of norepinephrine plasma concentration in assessment of sympathetic nervous activity; Characteristics of subjects; Changes in norepinephrine levels of...

  • Effect of tail suspension on haemodynamics in intact and sympathectomized rats. Tarasova, O.; Figourina, I.; Zotov, A.; Borovik, A.; Vinogradova, O. // European Journal of Applied Physiology;Sep2001, Vol. 85 Issue 5, p397 

    The effect of a 2-week tail suspension on mean arterial pressure (MAP) and pulse interval (PI) was studied in conscious chronically instrumented intact and sympathectomized rats. Sympathectomy was induced by 6-hydroxydopamine (100 mg·kg–1, i.v.), injected 1 day before, and on days 5...

  • Spectral indices of cardiovascular adaptations to short-term simulated microgravity exposure. Patwardhan, A.R.; Evans, J.M. // Integrative Physiological & Behavioral Science;Jul-Sep95, Vol. 30 Issue 3, p201 

    Investigates the effects of exposure on the baseline autonomic balance in cardiovascular regulation using spectral analysis of cardiovascular variables measured during supine rest. Indication of a reduced heart rate power in the respiratory frequency region; Indication of an increase in the low...

  • Simulation of Local Blood Flow Gain. Yavelov, I.; Goncharenko, A.; Izrailovich, M.; Katanov, D. // Biomedical Engineering;May2014, Vol. 48 Issue 1, p53 

    A device for studying the pulsation wave and vibration signals produced by the cardiovascular system was developed at the Blagonravov Institute of Mechanical Engineering, Russian Academy of Sciences, for cardiac rhythm research. A model of cardiac rhythm and pulsation wave was constructed based...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics