Hemodynamic responses to 1 MAC desflurane inhalation during anesthesia induction with propofol bolus and remifentanil continuous infusion: a prospective randomized single-blind clinical investigation

Abstract

Background: Desflurane is not recommended during anesthesia induction because of its sympathetic stimulation effect, particularly in patients with myocardial ischemic disease. To date, the hemodynamic response to 1 MAC desflurane inhalation in combination with remifentanil infusion during anesthesia induction has rarely been reported.

Methods: This investigation was designed to compare hemodynamic responses to 1 MAC desflurane (group D, n = 200) with sevoflurane (group S, n = 200) during anesthesia induction and endotracheal intubation in adult patients undergoing elective spine surgery. Subgroup analysis of the different age subgroups was also performed. With continuous infusion of remifentanil 0.1 μg/kg/min, anesthesia was induced with propofol bolus, and endotracheal intubation was performed after muscle relaxation. Heart rate (HR) and mean arterial blood pressure (MAP) were measured every minute for 5 min after anesthesia induction (T1-5) and after endotracheal intubation (T6-10).

Results: HR was significantly higher in group D (n = 182) than in group S (n = 173) at T3-10 except at T6 (1 min after intubation) (all P < 0.05). In the age-based subgroup analyses, which subdivided the group D and S into four subgroups based on patient's age, the changes in HR from baseline values were significantly different between the coeval subgroups of patients in their 20-29 years and 30-39 years of age (all P < 0.05). MAP was reduced from baseline value, irrespective of group and age.

Conclusion: Inhalation of 1 MAC desflurane during anesthesia induction with propofol bolus and remifentanil continuous infusion and during endotracheal intubation was more likely to induce elevations in HR more likely than 1 MAC sevoflurane, especially in younger patients.

Trial registration: This study was registered in the Clinical Research Information Service (CRIS, http://cris.nih.go.kr ) of the Republic of Korea on Feb 12, 2016 (Registration No. KCT 0,001,813).

Keywords: Age; Desflurane; Hemodynamic response; Remifentanil; Sevoflurane.

Fig. 1

CONSORT flow diagram, showing cases included and reasons for exclusion. CONSORT, Consolidated Standards of Reporting Trials

Fig. 2

Changes in hemodynamic parameters after anesthesia induction and endotracheal intubation in groups D and S. Data are represented as mean ± standard. D: Desflurane; S: Sevoflurane; a) HR: heart rate; b) MAP: mean arterial blood pressure; T0: baseline; T1-5: 1–5 min after anesthesia induction; T6-10: 1–5 min after endotracheal intubation; P group x time: P values of group and time interaction obtained by the linear mixed model. ^*P < 0.05 between groups D and S, ^†P < 0.05 versus T0 between groups D and S

Fig. 3

Changes in heart rate (HR) after anesthesia induction and endotracheal intubation in groups D and S. Data are represented as mean ± standard. D: Desflurane; S: Sevoflurane; Patients a) 20–29, b) 30–39, c) 40–49 and d) 50–59 years old; T0: baseline; T1-5: 1–5 min after anesthesia induction; T6-10: 1–5 min after endotracheal intubation; P group x time: P values of group and time interaction obtained by the linear mixed model. ^*P < 0.05 between groups D and S, ^†P < 0.05 versus T0 between groups D and S

Fig. 4

Changes in mean arterial pressure (MAP) after anesthesia induction and endotracheal intubation in groups D and S. Data are represented as mean ± standard. D: Desflurane; S: Sevoflurane; Patients a) 20–29, b) 30–39, c) 40–49 and d) 50–59 years old; T0: baseline; T1-5: 1–5 min after anesthesia induction; T6-10: 1–5 min after endotracheal intubation; P group x time: P values of group and time interaction obtained by the linear mixed model. ^*P < 0.05 between groups D and S, ^†P < 0.05 versus T0 between groups D and S