OJAnes  Vol.4 No.1 , January 2014
Remifentanil Has Sufficient Hypnotic and Amnesic Effect for Induction of Anesthesia by Itself
Abstract: With a small-dose remifentanil, some patients showed no reaction and did not remember it postoperatively. We, therefore, hypothesized that remifentanil may decrease the level of consciousness and/or exhibit amnesic effect when stimulations are avoided. Thirty-patients were divided into two groups: non-stimulation group and stimulation group. Anesthesia was induced with 1 micro-g·kg?1·min?1 of remifentanil using no additional hypnotic agent. In the non-stimulation group, patients were left free from any stimulation except non-invasive blood pressure monitoring. In the stimulation group, patients were asked to follow verbal commands. The level of consciousness was evaluated with electroencephalogram and BIS-value derived from it. In the non-stimulation group, all patients reached the decreased level of consciousness in 5 minutes. In the stimulation group, however, 14 patients were judged to be still conscious. 10 patients could open their mouth at the 5th minute, but 9 of these 10 patients did not remember it postoperatively. In conclusion, remifentanil, with no additional anesthetics, exhibited hypnotic and amnesic effects when stimulations were kept minimal.
Cite this paper: T. Yokoyama, E. Sakamoto, F. Yamasaki, K. Yamashita, T. Yatabe and K. Suwa, "Remifentanil Has Sufficient Hypnotic and Amnesic Effect for Induction of Anesthesia by Itself," Open Journal of Anesthesiology, Vol. 4 No. 1, 2014, pp. 8-12. doi: 10.4236/ojanes.2014.41002.

[1]   J. B. Streisand, P. L. Bailey, L. LeMaire, M. A. Ashburn, S. D. Tarver, J. Varvel and T. H. Stanley, “FentanylInduced Rigidity and Unconsciousness in Human Volunteers. Incidence, Duration, and Plasma Concentrations,” Anesthesiology, Vol. 78, No. 4, 1993, pp. 629-634.

[2]   T. Nishiyama, “The Effects of Auditory Evoked Potential Click Sounds on Bispectral Index and Entropy,” Anesthesia & Analgesia, Vol. 107, No. 2, 2008, pp. 545-548.

[3]   G. W. Haber and R. S. Litman, “Generalized Tonic-Clonic Activity after Remifentanil Administration,” Anesthesia & Analgesia, Vol. 93, No. 6, 2001, pp. 1532-1533.

[4]   J. Nielsen and M. Krøigaard, “Seizures in a 77-Year-Old Woman after a Bolus Dose of Remifentanil,” Acta Anaesthesiologica Scandinavica, Vol. 48, No. 2, 2004, pp. 253-254.

[5]   R. Jhaveri, P. Joshi, R. Batenhorst, V. Baughman and P. S. Glass, “Dose Comparison of Remifentanil and Alfentanil for Loss of Consciousness,” Anesthesiology, Vol. 87, No. 2, 1997, pp. 253-259.

[6]   J. C. Sigl and N. G. Chamoun, “An Introduction to Bispectral Analysis for the Electroencephalogram,” Journal of Clinical Monitoring and Computing, Vol. 10, No. 6, 1994, pp. 392-404.

[7]   P.S. Glass, M. Bloom, L. Kearse, C. Rosow, P. Sebel and P. Manberg, “Bispectral Analysis Measures Sedation and Memory Effects of Propofol, Midazolam, Isoflurane, and Alfentanil in Healthy Volunteers,” Anesthesiology, Vol. 86, No. 4, 1997, pp. 836-847.

[8]   M. J. Griffiths, A. W. Preece and J. L. Green, “Monitoring Sedation Levels by EEG Spectral Analysis,” Anesthesia Progress, Vol. 38, No. 6, 1991, pp. 227-231.

[9]   G. Barr, R. E. Anderson, A. Owall and J. G. Jakobsson, “Effects on the Bispectral Index during Medium-High Dose Fentanyl Induction with or without Propofol Supplement,” Acta Anaesthesiologica Scandinavica, Vol. 44, No. 7, 2000, pp. 807-811.

[10]   S. C. Manyam, D. K. Gupta, K. B. Johnson, J. L. White, N. L. Pace, D. R. Westenskow and T. D. Egan, “When Is a Bispectral Index of 60 too Low?: Rational Processed Electroencephalographic Targets Are Dependent on the Sedative-Opioid Ratio,” Anesthesiology, Vol. 106, No. 3, 2007, pp. 472-483.

[11]   D. K. Gupta, “Processed EEG (Bispectral Index) Is Not Appropriate for Characterizing Opioid Sedation,” Clinical Pharmacology & Therapeutics, Vol. 83, No. 5, 2008, pp. 667-668.

[12]   A. Yli-Hankala, “Awareness Despite Low Spectral Entropy Values,” Anesthesia & Analgesia, Vol. 106, No. 5, 2008, p. 1585.

[13]   J. Bruhn, T. W. Bouillon and S. L. Shafer, “Electromyographic Activity Falsely Elevates the Bispectral Index,” Anesthesiology, Vol. 92, No. 5, 2000, pp. 1485-1487.

[14]   K. B. Domino, K. L. Posner, R. A. Caplan and F. W. Cheney, “Awareness during Anesthesia: A Closed Claims Analysis,” Anesthesiology, Vol. 90, No. 4, 1999, pp. 1053-1061.

[15]   M. Nishimura, Y. Shiigi and H. Kaneto, “State Dependent and/or Direct Memory Retrieval by Morphine in Mice,” Psychopharmacology (Berl), Vol. 100, No. 1, 1990, pp. 27-30.

[16]   M. R. Zarrindast and A. Rezayof, “Morphine State-Dependent Learning: Sensitization and Interactions with Dopamine Receptors,” European Journal of Pharmacology, Vol. 497, No. 2, 2004, pp. 197-204.

[17]   J. Nauta, S. de Lange, D. Koopman, J. Spierdijk, J. van Kleef and T. H. Stanley, “Anesthetic Induction with Alfentanil: A New Short-Acting Narcotic Analgesic,” Anesthesia & Analgesia, Vol. 61, No. 3, 1982, pp. 267-272.

[18]   R. J. Fragen, E. H. Hanssen, P. A. Denissen, L. H. Booij and J. F. Crul, “Disoprofol (ICI 35868) for Total Intravenous Anaesthesia,” Acta Anaesthesiologica Scandinavica, Vol. 27, No. 2, 1983, pp. 113-116.

[19]   J. C. Raeder and G. Misvaer, “Comparison of Propofol Induction with Thiopentone or Methohexitone in Short Outpatient General Anaesthesia,” Acta Anaesthesiologica Scandinavica, Vol. 32, No. 8, 1988, pp. 607-613.

[20]   P. S. Pagel and D. C. Warltier, “Anesthetics and Left Ventricular Function,” In: D. C. Waltier, Ed., Ventricular Function, Williams & Wilkins, Baltimore, 1995, pp. 213-252.