A multicenter evaluation of total intravenous anesthesia with remifentanil and propofol for elective inpatient surgery

Charles W. Hogue, T. Andrew Bowdle, Colleen O'Leary, Deryck Duncalf, Rafael Miguel, Melvin Pitts, James Streisand, George Kirvassilis, Brenda Jamerson, Sally McNeal, Randal Batenhorst

Research output: Contribution to journalArticlepeer-review

208 Scopus citations


Remifentanil is a μ-opioid receptor agonist with a context sensitive half-time of 3 min and an elimination half-life ≤10 min. This study sought to evaluate the efficacy of remifentanil and propofol total in(ravenous anesthesia (TIVA) in 161 patients undergoing inpatient surgery. Remifentanil 1 μg/kg was given intravenously (IV) followed by one of two randomized infusion rates: small dose (0.5 μg · kg-1 · min-1) or large dose (1 μg · kg-1 · min-1). Propofol (0.5-1.0 mg/kg IV bolus and 75 μg · kg-1 · min-1 infusion) and vecuronium were also given. Remifentanil infusions were decreased by 50% after tracheal intubation. End points included responses (hypertension, tachycardia, and somatic responses) to tracheal intubation and surgery. More patients in the small-dose than in the large-dose group responded to tracheal intubation with hypertension and/or tachycardia (25% vs 6%; P = 0.003) but there were no other differences between groups in intraoperative responses. Recovery from anesthesia was within 3-7 min in both groups. The most frequent adverse events were hypotension (systolic blood pressure [BP] < 80 mm Hg or mean BP < 60 mm Hg) during anesthesia induction (10% small-dose versus 15% large-dose group; P = not significant [NS]) and hypotension (27% small-dose versus 30% large-dose group; P = NS), and bradycardia (7% small-dose versus 19% large-dose group; P = NS) during maintenance. In conclusion, when combined with propofol 75 μg · kg-1 · min-1, remifentanil 1 μg/kg IV as a bolus followed by an infusion of 1.0 μg · kg-1 · min-1 effectively controls responses to tracheal intubation. After tracheal intubation, remifentanil 0.25-4.0 μg · kg-1 · min-1 effectively controlled intraoperative responses while allowing for rapid emergence from anesthesia.

Original languageEnglish (US)
Pages (from-to)279-285
Number of pages7
JournalAnesthesia and analgesia
Issue number2
StatePublished - 1996
Externally publishedYes

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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