High-dose remifentanil does not impair cerebrovascular carbon dioxide reactivity in healthy male volunteers

Walter Klimscha, Roman Ulirich, Christian Nasel, Wolfgang Dietrich, Udo M. Illievich, Eckart Wildling, Edda Tschernko, Claudia Weidekamm, Leopold Adler, Georg Heikenwälder, G. Horváth, Robert N. Sladen

Research output: Contribution to journalArticle

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Abstract

Background: Cerebrovascular carbon dioxide reactivity during high-dose remifentanil infusion was investigated in volunteers by measurement of regional cerebral blood flow (rCBF) and mean CBF velocity (CBFv). Methods: Ten healthy male volunteers with a laryngeal mask for artificial ventilation received remifentanil at an infusion rate of 2 and 4 μg · kg-1 · min-1 under normocapnia, hypocapnia, and hypercapnia. Stable xenon-enhanced computed tomography and transcranial Doppler ultrasonography of the left middle cerebral artery were used to assess rCBF and mean CBFv, respectively. If required, blood pressure was maintained within baseline values with intravenous phenylephrine to avoid confounding effects of altered hemodynamics. Results: Hemodynamic parameters were maintained constant over time. Remifentanil infusion at 2 and 4 μg · kg-1 · min-1 significantly decreased rCBF and mean CBFv. Both rCBF and mean CBFv increased as the arterial carbon dioxide tension increased from hypocapnia to hypercapnia, indicating that cerebrovascular reactivity remained intact. The average slopes of rCBF reactivity were 0.56 ± 0.27 and 0.49 ± 0.28 ml · 100 g-1 · min-1 · mmHg-1 for 2 and 4 μg·kg-1·min -1 remifentanil, respectively (relative change in percent/mmHg: 1.9 ± 0.8 and 1.6 ± 0.5, respectively). The average slopes for mean CBFv reactivity were 1.61 ± 0.95 and 1.54 ± 0.83 cm · s-1 · mmHg-1 for 2 and 4 μg · kg -1 · min-1 remifentanil, respectively (relative change in percent/mmHg: 1.86 ± 0.59 and 1.79 ± 0.59, respectively). Preanesthesia and postanesthesia values of rCBF and mean CBFv did not differ. Conclusion: High-dose remifentanil decreases rCBF and mean CBFv without impairing cerebrovascular carbon dioxide reactivity. This, together with its known short duration of action, makes remifentanil a useful agent in the intensive care unit when sedation that can be titrated rapidly is required.

Original languageEnglish
Pages (from-to)834-840
Number of pages7
JournalAnesthesiology
Volume99
Issue number4
DOIs
Publication statusPublished - Oct 1 2003

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Cerebrovascular Circulation
Regional Blood Flow
Carbon Dioxide
Healthy Volunteers
Hypocapnia
Hypercapnia
Hemodynamics
Doppler Transcranial Ultrasonography
Laryngeal Masks
Xenon
Middle Cerebral Artery
Phenylephrine
remifentanil
Intensive Care Units
Volunteers
Tomography
Blood Pressure

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Klimscha, W., Ulirich, R., Nasel, C., Dietrich, W., Illievich, U. M., Wildling, E., ... Sladen, R. N. (2003). High-dose remifentanil does not impair cerebrovascular carbon dioxide reactivity in healthy male volunteers. Anesthesiology, 99(4), 834-840. https://doi.org/10.1097/00000542-200310000-00014

High-dose remifentanil does not impair cerebrovascular carbon dioxide reactivity in healthy male volunteers. / Klimscha, Walter; Ulirich, Roman; Nasel, Christian; Dietrich, Wolfgang; Illievich, Udo M.; Wildling, Eckart; Tschernko, Edda; Weidekamm, Claudia; Adler, Leopold; Heikenwälder, Georg; Horváth, G.; Sladen, Robert N.

In: Anesthesiology, Vol. 99, No. 4, 01.10.2003, p. 834-840.

Research output: Contribution to journalArticle

Klimscha, W, Ulirich, R, Nasel, C, Dietrich, W, Illievich, UM, Wildling, E, Tschernko, E, Weidekamm, C, Adler, L, Heikenwälder, G, Horváth, G & Sladen, RN 2003, 'High-dose remifentanil does not impair cerebrovascular carbon dioxide reactivity in healthy male volunteers', Anesthesiology, vol. 99, no. 4, pp. 834-840. https://doi.org/10.1097/00000542-200310000-00014
Klimscha, Walter ; Ulirich, Roman ; Nasel, Christian ; Dietrich, Wolfgang ; Illievich, Udo M. ; Wildling, Eckart ; Tschernko, Edda ; Weidekamm, Claudia ; Adler, Leopold ; Heikenwälder, Georg ; Horváth, G. ; Sladen, Robert N. / High-dose remifentanil does not impair cerebrovascular carbon dioxide reactivity in healthy male volunteers. In: Anesthesiology. 2003 ; Vol. 99, No. 4. pp. 834-840.
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AU - Ulirich, Roman

AU - Nasel, Christian

AU - Dietrich, Wolfgang

AU - Illievich, Udo M.

AU - Wildling, Eckart

AU - Tschernko, Edda

AU - Weidekamm, Claudia

AU - Adler, Leopold

AU - Heikenwälder, Georg

AU - Horváth, G.

AU - Sladen, Robert N.

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N2 - Background: Cerebrovascular carbon dioxide reactivity during high-dose remifentanil infusion was investigated in volunteers by measurement of regional cerebral blood flow (rCBF) and mean CBF velocity (CBFv). Methods: Ten healthy male volunteers with a laryngeal mask for artificial ventilation received remifentanil at an infusion rate of 2 and 4 μg · kg-1 · min-1 under normocapnia, hypocapnia, and hypercapnia. Stable xenon-enhanced computed tomography and transcranial Doppler ultrasonography of the left middle cerebral artery were used to assess rCBF and mean CBFv, respectively. If required, blood pressure was maintained within baseline values with intravenous phenylephrine to avoid confounding effects of altered hemodynamics. Results: Hemodynamic parameters were maintained constant over time. Remifentanil infusion at 2 and 4 μg · kg-1 · min-1 significantly decreased rCBF and mean CBFv. Both rCBF and mean CBFv increased as the arterial carbon dioxide tension increased from hypocapnia to hypercapnia, indicating that cerebrovascular reactivity remained intact. The average slopes of rCBF reactivity were 0.56 ± 0.27 and 0.49 ± 0.28 ml · 100 g-1 · min-1 · mmHg-1 for 2 and 4 μg·kg-1·min -1 remifentanil, respectively (relative change in percent/mmHg: 1.9 ± 0.8 and 1.6 ± 0.5, respectively). The average slopes for mean CBFv reactivity were 1.61 ± 0.95 and 1.54 ± 0.83 cm · s-1 · mmHg-1 for 2 and 4 μg · kg -1 · min-1 remifentanil, respectively (relative change in percent/mmHg: 1.86 ± 0.59 and 1.79 ± 0.59, respectively). Preanesthesia and postanesthesia values of rCBF and mean CBFv did not differ. Conclusion: High-dose remifentanil decreases rCBF and mean CBFv without impairing cerebrovascular carbon dioxide reactivity. This, together with its known short duration of action, makes remifentanil a useful agent in the intensive care unit when sedation that can be titrated rapidly is required.

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