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Sex-Related Differences in the Effect-Site Concentration of Remifentanil for Preventing QTc Interval Prolongation Following Intubation in Elderly Patients with a Normal QTc Interval

 S. Y. Kim  ;  M. K. Song  ;  M.-S. Kim  ;  E. H. Kim  ;  D. W. Han 
 DRUGS & AGING, Vol.31(9) : 695-702, 2014 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Anesthesia, General/adverse effects ; Anesthetics, Intravenous/administration & dosage* ; Anesthetics, Intravenous/pharmacology ; Arrhythmias, Cardiac/prevention & control* ; Drug Administration Schedule ; Female ; Health Services for the Aged ; Heart Conduction System/drug effects ; Humans ; Inhibitory Concentration 50 ; Intubation, Intratracheal/adverse effects ; Male ; Piperidines/administration & dosage* ; Piperidines/pharmacology ; Postoperative Complications/prevention & control* ; Propofol/administration & dosage ; Sex Factors
Mean Arterial Pressure ; Tracheal Intubation ; Remifentanil ; Ephedrine ; Cardiac Repolarisation
BACKGROUND: Female sex and age more than 65 years are common risk factors for the development of torsades de pointes in association with heart rate-corrected QT (QTc) interval prolongation, which can be induced by tracheal intubation during general anaesthesia. However, the administration of remifentanil can prevent intubation-induced QTc interval prolongation. We compared sex-related differences in the effect-site concentration (Ce) of remifentanil for preventing QTc interval prolongation among elderly patients. METHODS: Twenty-two female and 22 male patients older than 65 years were enrolled. Anaesthesia was induced with remifentanil and propofol using a target-controlled infusion. The Ce of remifentanil for maintaining a QTc interval prolongation <15 ms following intubation was determined for each sex using the isotonic regression method and a bootstrapping approach following Dixon's up-and-down method. RESULTS: The Ce of remifentanil for preventing QTc interval prolongation following intubation in 50 % of the population (EC50) and 95 % of the population (EC95) were significantly lower in females than in males. Isotonic regression revealed that the EC50 (83 % confidence interval) of remifentanil was 3.50 (2.95-4.08) ng/mL in females and 4.38 (4.08-4.63) ng/mL in males. The EC95 (95 % confidence interval) of remifentanil was 4.43 (4.25-4.48) ng/mL in females and 4.94 (4.78-4.98) ng/mL in males. CONCLUSIONS: Target-controlled infusion of remifentanil is effective in attenuating QTc interval prolongation after intubation among elderly patients and the Ce of remifentanil is lower in females than in males.
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1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Min Soo(김민수) ORCID logo https://orcid.org/0000-0001-8760-4568
Kim, So Yeon(김소연) ORCID logo https://orcid.org/0000-0001-5352-157X
Song, Mi Kyung(송미경)
Han, Dong Woo(한동우) ORCID logo https://orcid.org/0000-0002-8757-663X
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