Work

Remifentanil to Maintain Unresponsiveness While Propofol Concentrations Decline Before Emergence in Two Patients With Prior Emergence Agitation

Year: 2026

Type: article

Abstract: Background: Emergence agitation is an unpredictable and potentially harmful state during recovery from general anesthesia. We describe a pharmacokinetic strategy intended to permit the propofol concentration to decline further before emergence while maintaining unresponsiveness with remifentanil. Case: Two adults experienced severe emergence agitation after propofol-remifentanil total intravenous anesthesia. During subsequent procedures, propofol was discontinued well before emergence, and remifentanil was continued or administered intermittently while estimated propofol effect-site concentrations declined. Both patients subsequently emerged calmly without observed hemodynamic or ventilatory compromise. Conclusions: These findings are hypothesis-generating. They suggest that separating the decline in propofol concentration from the time of awakening warrants prospective study as a strategy to reduce emergence agitation in patients with a prior episode. Modeled rather than measured concentrations, uncontrolled clinical factors, and the use of large remifentanil boluses limit any causal or dosing conclusions.

Source: Case Reports in Anesthesiology

DOI: 10.1155/cria/9359809

Authors: Jeffrey D. Swenson, G. Colton Gardner, Ken B. Johnson, Evelyn C. Loose, Alastair Eric Moody

Institutions: University of Utah, University of Arizona

Language: English

Topic: Anesthesia and Sedative Agents

Subfield: Anesthesiology and Pain Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $790