Anaesthetic drugs & techniques
Effect of Sevoflurane, Propofol, and Remifentanil on Hemodynamic Response to Pneumoperitoneum and Laparoscopic Surgery: A Randomized Controlled Trial
Authors' conclusion
The relative potency of sevoflurane to propofol in reducing the MAP response to pneumoperitoneum is similar to that for tolerance of laryngoscopy but differs from that for hypnotic endpoints. The effect of remifentanil on reducing the MAP response is similar whether it is combined with sevoflurane or propofol. Because titration to a dynamic clinical end point decouples the traditional relationship between drug input and clinical outcome, titration data cannot be used to validate pharmacodynamic models.
Study context
- Population
- American Society of Anesthesiologists (ASA) physical status I or II patients scheduled for elective laparoscopic surgerypatients whose data were analyzed
- Participants
- 155 participants
- Comparison
- Different combinations of sevoflurane-remifentanil, propofol-remifentanil, or sevoflurane-propofol-remifentanil
Methodological detailsup-and-down method, linear-additive interaction model, linear mixed-effects model
- Up-and-down method
- Linear-additive interaction model
- Linear mixed-effects model
Primary result
As reported in the abstract
Sevoflurane, Ce50 BARPP (95% CI)
1.56 (1.18-1.95) vol%
Propofol, Ce50 BARPP (95% CI)
4.82 (4.29-5.36) µg mL-1
Further findings
Remifentanil concentration during surgery
Ce50 BARPP at remifentanil 3 ng/ml plus either propofol 1.8 µg mL-1 or sevoflurane 0.6 vol%
- Sevoflurane (with propofol 1.8 µg mL-1)
- 2.2 (2.0-2.4) vol%
- Propofol (with sevoflurane 0.6 vol%)
- 5.9 (5.7-6.0) µg mL-1
Drug interaction model
- Propofol scaling factor (scaleSP), potency of propofol relative to sevoflurane
- 0.31 (0.19-0.44)
- Remifentanil constant kremi, hypnotic-sparing effect of remifentanil
- 2.03 (0.82-3.24)
Mean arterial pressure (MAP) vs remifentanil concentrations · during surgery
- The MAP did not correlate with the remifentanil concentrations, demonstrating evidence for the drug titration paradox
Original publication
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