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The effect of remifentanil on the middle latency auditory evoked response and haemodynamic measurements with and without the stimulus of orotracheal intubation

Published online by Cambridge University Press:  23 December 2004

D. R. Wright ,
C. Thornton ,
K. Hasan ,
D. J. A. Vaughan ,
C. J. Doré  and
M. D. Brunner
D. R. Wright
Affiliation:
Imperial College, Department of Anaesthetics and Intensive Care, Division of Surgery, Anaesthetics and Intensive Care, Faculty of Medicine, Northwick Park Hospital, Harrow, Middlesex; UK
C. Thornton
Affiliation:
Imperial College, Department of Anaesthetics and Intensive Care, Division of Surgery, Anaesthetics and Intensive Care, Faculty of Medicine, Northwick Park Hospital, Harrow, Middlesex; UK
K. Hasan
Affiliation:
Imperial College, Department of Anaesthetics and Intensive Care, Division of Surgery, Anaesthetics and Intensive Care, Faculty of Medicine, Northwick Park Hospital, Harrow, Middlesex; UK
D. J. A. Vaughan
Affiliation:
Imperial College, Department of Anaesthetics and Intensive Care, Division of Surgery, Anaesthetics and Intensive Care, Faculty of Medicine, Northwick Park Hospital, Harrow, Middlesex; UK
C. J. Doré
Affiliation:
MRC Clinical Trials Unit, London, UK
M. D. Brunner
Affiliation:
Imperial College, Department of Anaesthetics and Intensive Care, Division of Surgery, Anaesthetics and Intensive Care, Faculty of Medicine, Northwick Park Hospital, Harrow, Middlesex; UK
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Summary

Background and objective: Changes in the middle latency auditory evoked response following the administration of opioids have been shown. However, it remains unclear as to whether these changes are due to a direct depressant effect of opioids on the middle latency auditory evoked response itself, or an indirect effect on account of their action in attenuating central nervous system arousal associated with noxious stimuli. By comparing changes in the middle latency auditory evoked response in intubated and non-intubated patients, receiving saline or remifentanil in different doses, this study attempts to answer this question.

Methods: Fifty-four patients were anaesthetized with isoflurane and nitrous oxide (0.9 MAC) and randomized to 1–6 groups. Groups 1–3 received a bolus injection of either saline 0.9%, low-dose remifentanil (1 μg kg−1) or high-dose remifentanil (3 μg kg−1) prior to intubation of the trachea. Groups 4–6 were not intubated following the bolus injection.

Results: Pa and Nb amplitudes of the middle latency auditory evoked response increased by 82% and 79% with intubation in the saline group (P < 0.005) and these changes were not seen in the patients given remifentanil. There was a significant linear trend for the reduction in Pa and Nb amplitude with increasing remifentanil dose (P < 0.05). In the absence of endotracheal intubation remifentanil had no effect on either the amplitudes or latencies of the waves Pa and Nb and there was no effect of dose. For the haemodynamic measurements remifentanil attenuated the pressor response to intubation (P < 0.001) and had a significant dose-related effect (P < 0.001) in the absence of intubation.

Conclusions: We demonstrated an effect of remifentanil on both the middle latency auditory evoked response and haemodynamic changes to endotracheal intubation. For the non-intubated patients there was only an effect of remifentanil on the haemodynamic measurements. This suggests that remifentanil has an effect on the middle latency auditory evoked response in attenuating the arousal associated with intubation of the trachea but has no effect in the absence of a stimulus.

Keywords

ANAESTHETICS, INHALATION, nitrous oxideANAESTHETICS, VOLATILE, isofluraneANALGESICS, OPIOID, remifentanilEVOKED POTENTIALS, auditoryHAEMODYNAMICS, blood pressureINTUBATION, INTRATRACHEAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 7 , July 2004 , pp. 509 - 516
Copyright
2004 European Society of Anaesthesiology

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References

Thornton C, Sharpe RM. Evoked responses in anaesthesia. Br J Anaesth 1998; 81: 771–781.Google Scholar
Thornton C, Konieczko K, Jones JG, Jordan C, Doré CJ, Heneghan CPH. Effect of surgical stimulation on the auditory evoked response. Br J Anaesth 1998; 60: 372–378.Google Scholar
Shinner G, Sharpe RM, Thornton C, Doré CJ, Brunner MD. Effect of bolus doses of alfentanil on the arousal response to intubation, as assessed by the auditory evoked response. Br J Anaesth 1999; 82: 925–928.Google Scholar
Schwender D, Rimkus T, Haessler R, Klasing S, Pöppel E, Peter K. Effects of increasing doses of alfentanil, fentanyl and morphine on mid-latency auditory evoked potentials. Br J Anaesth 1993; 71: 622–628.Google Scholar
Schwender D, Weninger E, Daunderer M, Klasing S, Madler C. Anesthesia with increasing doses of sufentanil and midlatency evoked potentials in humans. Anesth Analg 1995; 80: 499–505.Google Scholar
Crabb I, Thornton C, Konieczko KM, et al. Remifentanil reduces auditory and somatosensory evoked responses during isoflurane anaesthesia in a dose-dependent manner. Br J Anaesth 1996; 76: 795–801.Google Scholar
Jordan C, Weller C, Thornton C, Newton DEF. Monitoring evoked potentials during surgery to assess the level of anaesthesia. J Med Eng Technol 1997; 19: 77–79.Google Scholar
Minto CF, Schnider TW, Egan TD, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil: I. Model development. Anesthesiology 1997; 86: 10–23.Google Scholar
Shafer SL, Varvel JR. Pharmacokinetics, pharmacodynamics, and rational opioid selection. Anesthesiology 1991; 74: 53–63.Google Scholar
Egan TD, Minto CF, Hermann DJ, Barr J, Muir KT, Shafer SL. Remifentanil versus alfentanil: comparative pharmacokinetics and pharmacodynamics in healthy adult male volunteers. Anesthesiology 1996; 84: 821–833.Google Scholar
Jones BE. Basic mechanisms of sleep-wake states. In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. Philadelphia, USA: W. B. Saunders Company, 2000: 134–154.
Schwender D, Kaiser A, Klasing S, Peter K, Pöppel E. Midlatency auditory evoked potentials and explicit and implicit memory in patients undergoing cardiac surgery. Anesthesiology 1994; 80: 493–501.Google Scholar
Katoh T, Ikeda K. The effects of fentanyl on sevoflurane requirements for loss of consciousness and skin incision. Anesthesiology 1998; 88: 18–24.Google Scholar
Kazama T, Ikeda K, Morita K. Reduction by fentanyl of the Cp50 values of propofol and hemodynamic responses to various noxious stimuli. Anesthesiology 1997; 87: 213–227.Google Scholar
Glass PSA. Anesthetic drug interactions: an insight into general anesthesia – its mechanism and dosing strategies. Anesthesiology 1998; 88: 5–6.Google Scholar
Iselin-Chaves IA, El Moalem HE, Gan TJ, Ginsberg B, Glass PSA. Changes in the auditory evoked potentials and the bispectral index following propofol or propofol and alfentanil. Anesthesiology 2000; 92: 1300–1310.Google Scholar
Thompson JP, Hall AP, Russell J, Cagney B, Rowbotham DJ. Effect of remifentanil on the haemodynamic response to orotracheal intubation. Br J Anaesth 1998; 80: 467–469.Google Scholar
Hall AP, Thompson JP, Leslie NAP, Fox AJ, Kumar N, Rowbotham DJ. Comparison of different doses of remifentanil on the cardiovascular response to laryngoscopy and tracheal intubation. Br J Anaesth 2000; 84: 100–102.Google Scholar
Guignard B, Menigaux C, Dupont X, Fletcher D, Chauvin M. Anesth Analg 2000; 90:161–167.Google Scholar