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Peer-reviewedCC BY 4.0Case Reports in Anesthesiology

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

  • Jeffrey D. Swenson1
  • G. Colton Gardner1
  • Ken B. Johnson2
  • Evelyn C. Loose1
  • Alastair Eric Moody1
  1. 1Department of Anesthesiology University of Utah Salt Lake City Utah USA utah.edu
  2. 2Department of Anesthesiology The University of Arizona College of Medicine 1501 N. Campbell Ave. Tucson 85724 Arizona USA arizona.edu
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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.

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Cite

BibTeXRIS
BibTeX
@article{swenson2026remifentanil,
  title = {{Remifentanil to Maintain Unresponsiveness While Propofol Concentrations Decline Before Emergence in Two Patients With Prior Emergence Agitation}},
  author = {Jeffrey D. Swenson and G. Colton Gardner and Ken B. Johnson and Evelyn C. Loose and Alastair Eric Moody},
  journal = {Case Reports in Anesthesiology},
  year = {2026},
  month = nov,
  doi = {10.1155/cria/9359809},
  url = {https://doi.org/10.1155/cria/9359809},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Remifentanil to Maintain Unresponsiveness While Propofol Concentrations Decline Before Emergence in Two Patients With Prior Emergence Agitation
AU  - Jeffrey D. Swenson
AU  - G. Colton Gardner
AU  - Ken B. Johnson
AU  - Evelyn C. Loose
AU  - Alastair Eric Moody
PY  - 2026
DA  - 2026/11/01
JO  - Case Reports in Anesthesiology
DO  - 10.1155/cria/9359809
UR  - https://doi.org/10.1155/cria/9359809
AB  - 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.
SN  - 2090-6382
SN  - 2090-6390
ER  -