No premedication was administered. Upon arrival in the OR, routine monitoring devices, including ECG lead II, pulse oximetry, non-invasive blood pressure and bispectral index, were applied. After confirming the patency of the peripheral intravenous (IV) route, remifentanil 0.1 μg/kg/min was initiated along with the rapid infusion of IV fluid. Thereafter, no further manipulation of the patient occurred in order to avoid overstressing the patient for 5–10 min. The hemodynamic parameters, including HR and mean arterial blood pressure (MAP), were measured twice at an interval of 3 min. The average value of two measurements was used as baseline value for hemodynamic comparison (T0).
After the IV injection of glycopyrrolate 0.2 mg, anesthesia was induced with propofol of 1–1.5 mg/kg IV over 30 s. If the patient was able to maintain a verbal response, propofol 10 mg IV was administered every 10 s. When loss of consciousness was confirmed, 1 MAC desflurane or sevoflurane in oxygen/air with a flow rate of > 5 L/min was administered via a face mask. To facilitate endotracheal intubation, rocuronium 0.6 mg/kg IV was administered along with lidocaine 30–40 mg IV to prevent injection pain. An end-tidal CO2 (ETCO2) level of 35–40 mmHg and a peak airway pressure of < 25 cm H2O were maintained with manual ventilation for 5 min. The patient’s tracheal was intubated using direct laryngoscopy or light wand, depending on the need for lumbar/thoracic or cervical spine surgery, respectively. Appropriate placement of the endotracheal tube was confirmed using bilateral chest auscultation and waveform observations of ETCO2. The ventilator was set to maintain ETCO2 between 35 and 40 mmHg with a tidal volume of 8 ml/kg.
After the IV injection of glycopyrrolate 0.2 mg, anesthesia was induced with propofol of 1–1.5 mg/kg IV over 30 s. If the patient was able to maintain a verbal response, propofol 10 mg IV was administered every 10 s. When loss of consciousness was confirmed, 1 MAC desflurane or sevoflurane in oxygen/air with a flow rate of > 5 L/min was administered via a face mask. To facilitate endotracheal intubation, rocuronium 0.6 mg/kg IV was administered along with lidocaine 30–40 mg IV to prevent injection pain. An end-tidal CO2 (ETCO2) level of 35–40 mmHg and a peak airway pressure of < 25 cm H2O were maintained with manual ventilation for 5 min. The patient’s tracheal was intubated using direct laryngoscopy or light wand, depending on the need for lumbar/thoracic or cervical spine surgery, respectively. Appropriate placement of the endotracheal tube was confirmed using bilateral chest auscultation and waveform observations of ETCO2. The ventilator was set to maintain ETCO2 between 35 and 40 mmHg with a tidal volume of 8 ml/kg.
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