• Neil M Agnew, Ngukhoon H Tan, Nigel D A Scawn, Stephen H Pennefather, and Glenn N Russell.
• Department of Anaesthesia, The Cardithoracic Centre Liverpool NHS Trust, Liverpool, England. neil.agnew@breathmail.net
• J. Cardiothorac. Vasc. Anesth. 2003 Jun 1;17(3):336-40.

ObjectiveTo compare the efficacy of different bolus doses of remifentanil, alfentanil, and saline at controlling the hemodynamic responses to day-case rigid bronchoscopy under general anesthesia.DesignProspective, randomized, double-blind, placebo-controlled study.SettingTertiary referral cardiothoracic hospital, single center.ParticipantsEighty consenting adults scheduled for elective day-case rigid bronchoscopy under general anesthesia.InterventionsPatients were randomized to receive a bolus of 10 micro g/kg of alfentanil, 1 micro g/kg of remifentanil, 2 micro g/kg of remifentanil or saline. After this, anesthesia was induced and maintained with a target-controlled propofol infusion (TCI) and succinylcholine was used for muscle relaxation. Heart rate and noninvasive arterial pressure were measured at 1-minute intervals throughout.Measurements And Main ResultsPatients' characteristics were similar in all 4 groups. There were no differences in time to return of spontaneous ventilation, wake-up times, or use of rescue vasopressors, and no patients complained of postoperative nausea. Remifentanil provided greater hemodynamic stability than alfentanil and a bolus of remifentanil of 2 micro g/kg significantly attenuated the rise in heart rate and was the most effective in preventing a rise in blood pressure.ConclusionsA bolus of 2 micro g/kg of remifentanil successfully attenuated the hemodynamic response to rigid bronchoscopy without delaying recovery.

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