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Carrasco, Genís

doi:10.1186/cc697

Cited by 103 publications

(17 citation statements)

References 18 publications

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“…Carrasco et al . [ 13 ] in his study on critically ill-patients concluded that RS score can be reliably used to assess sedation. The disadvantage of these sedation scores is the repeated verbal and tactile stimulation of the patient that is required to administer the drugs.…”

Section: Discussionmentioning

confidence: 99%

Comparison of subarachnoid block with bupivacaine and bupivacaine with fentanyl on entropy and sedation: A prospective randomized double-blind study

Varma

Darlong

Pandey

et al. 2014

J Anaesthesiol Clin Pharmacol

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Background and Aims:We studied the state entropy to monitor the sedative effect of subarachnoid block (SAB) using bupivacaine alone or combination of bupivacaine and fentanyl. The effect of use of fentanyl via the subarachnoid route on the sedation level was also studied using the entropy scores and the decrease in the requirement of propofol used as an adjuvant sedative drug.Materials and Methods:In this prospective randomized double-blind study, 30 patients of age 18-70 years requiring SAB were enrolled for the study. Patients with any known allergy to study drugs, contraindication for SAB, obesity, neurological or psychiatric disease on concurrent medication and refusal were excluded from the study. Patients were randomly allocated into two groups: Group C: SAB was administered with 2.5 mL (12.5 mg) of 0.5% hyperbaric bupivacaine; Group D: SAB was administered with 2.5 mL of 2 mL (10 mg) of 0.5% hyperbaric bupivacaine and 0.5 mL (25 μg) fentanyl. Propofol infusion was started if the state entropy (SE) value was ≥75, at the rate of 100 μg/kg/min till the SE value reaches in the range of 60-75 (recorded as onset time). Thereafter the infusion rate was titrated to maintain SE value between 60 and 75. The level of sedation was measured with SE and Ramsay sedation (RS) scale.Results:The demographic profile and baseline parameters, were comparable in two groups (P > 0.05). After SAB, decrease in SE and response entropy was noted in both the groups and fall was significant in Group D (P < 0.0001). The total propfol required in thew two groups were comparable being 3.97 ± 2.14 mg/kg in Group C and 3.41 ± 2.34 mg/kg in Group D (P = 0.342). The change in the mean RS values was from 1.17 ± 0.38 to 1.69 ± 0.47 in Group D (P = 0.06), whereas in Group C it was from 1.03 ± 0.18 to 1.43 ± 0.50 (P = 0.041) within 20 min of SAB.Conclusion:Subarachnoid block causes sedation per se, but the level of sedation is not clinically significant and the sedation caused is not enough to avoid sedative agents for allaying anxiety in patients intraoperatively. The sedative effect of SAB was enhanced by adding intrathecal fentanyl probably because of better quality of SAB. SE showed good correlation with RS scaling system. Therefore, SE may be used as reliable tool to titrate sedation in patients undergoing surgery under SAB.

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Section: Discussionmentioning

confidence: 99%

Comparison of subarachnoid block with bupivacaine and bupivacaine with fentanyl on entropy and sedation: A prospective randomized double-blind study

Varma

Darlong

Pandey

et al. 2014

J Anaesthesiol Clin Pharmacol

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“…In our study, DEX was used in addition to the standard algorithm of sedation applicable in our PICU which consists of sufentanyl and midazolam administration [ 26 , 27 ]. Similarly, sedation monitoring was also carried out by the Cook Scale, which has been routinely used by experienced and trained nurses’ team in our department [ 28 ]. This scale was originally adapted from Glasgow Coma Scale (GCS) based on the assessment of four reactions, such as eye opening, cough reflex, respiration and motor activity, in response to the stimulus, ranging from minimum of 4 (deep sedation) to maximum of 18 points (awakening).…”

Section: Methodsmentioning

confidence: 99%

The pharmacokinetics of dexmedetomidine during long-term infusion in critically ill pediatric patients. A Bayesian approach with informative priors

Wiczling

Bartkowska-Śniatkowska

Szerkus

et al. 2016

J Pharmacokinet Pharmacodyn

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The purpose of this study was to assess the pharmacokinetics of dexmedetomidine in the ICU settings during the prolonged infusion and to compare it with the existing literature data using the Bayesian population modeling with literature-based informative priors. Thirty-eight patients were included in the analysis with concentration measurements obtained at two occasions: first from 0 to 24 h after infusion initiation and second from 0 to 8 h after infusion end. Data analysis was conducted using WinBUGS software. The prior information on dexmedetomidine pharmacokinetics was elicited from the literature study pooling results from a relatively large group of 95 children. A two compartment PK model, with allometrically scaled parameters, maturation of clearance and t-student residual distribution on a log-scale was used to describe the data. The incorporation of time-dependent (different between two occasions) PK parameters improved the model. It was observed that volume of distribution is 1.5-fold higher during the second occasion. There was also an evidence of increased (1.3-fold) clearance for the second occasion with posterior probability equal to 62 %. This work demonstrated the usefulness of Bayesian modeling with informative priors in analyzing pharmacokinetic data and comparing it with existing literature knowledge.Electronic supplementary materialThe online version of this article (doi:10.1007/s10928-016-9474-0) contains supplementary material, which is available to authorized users.

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“…Given the limitations of the Ramsay scale, eg, providing only an estimated range of the patient's sedation level 15 and high subjectivity, 26 we recorded NTI. In recent years, NTI has been shown to be an effective and accurate monitoring method for sedation evaluation.…”

Section: Discussionmentioning

confidence: 99%

A New Real-time Method for Detecting the Effect of Fentanyl Using the Preoperative Pressure Pain Threshold and Narcotrend Index

et al. 2015

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Individual variability in the effects of opioid analgesics such as fentanyl remains a major challenge for tailored pharmacological treatment including postoperative analgesia. This study aimed to establish a new real-time method for detecting the effects of fentanyl and their individual differences in the preoperative period, using the pressure pain threshold (PPT) and Narcotrend index (NTI) test.Eighty women undergoing elective surgery under general anesthesia were enrolled in this randomized, double-blinded, placebo-controlled study to receive either intravenous fentanyl (Group F) or saline (Group S). Before (T1) and 5 (T2) and 10 min (T3) after intravenous injection, the PPT, NTI, respiratory rate, heart rate, blood pressure, and pulse oxygen saturation were measured. The initial time at which the Narcotrend index showed a decline was also recorded.In total, 40 patients in Group S and 38 patients in Group F were included in the final analysis. At 5 min and 10 min after intravenous fentanyl administration, the analgesic effect was determined by measuring the PPT, which was significantly increased (P < 0.001), and the sedative effect was detected using the NTI, which was significantly decreased (P < 0.001). The distribution of percentage changes of the PPT and NTI showed individual differences. At T2 and T3, the absolute changes in NTI and PPT were positively correlated (r = 0.444 at T2, P = 0.005; r = 0.332 at T3, P = 0.042).Through the PPT and NTI, it was feasible to easily detect the effects of fentanyl and their individual differences in real time before induction of anesthesia in the operation room. This method could potentially be applied to preoperatively determine patients’ sensitivity to fentanyl.

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Cited by 103 publications

References 18 publications

Comparison of subarachnoid block with bupivacaine and bupivacaine with fentanyl on entropy and sedation: A prospective randomized double-blind study

Comparison of subarachnoid block with bupivacaine and bupivacaine with fentanyl on entropy and sedation: A prospective randomized double-blind study

The pharmacokinetics of dexmedetomidine during long-term infusion in critically ill pediatric patients. A Bayesian approach with informative priors

A New Real-time Method for Detecting the Effect of Fentanyl Using the Preoperative Pressure Pain Threshold and Narcotrend Index

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