Determination of the ED95 of a single bolus dose of dexmedetomidine for adequate sedation in obese or nonobese children and adolescents

Wu, Bin; Shan, Jiaqi; Zhou, Quanhong; Wang, Li

doi:10.1016/j.bja.2020.11.037

Cited by 7 publications

(9 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, following a positive response (success of LOC), the next patient is randomized with a probability of 0.05 to the next lower dose and with a probability of 0.95 to the same dose. Examples of the biased coin up-and-down method in anesthesia studies finding an ED 95 dose can be found in numerous studies [25][26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups

Park

Lee

et al. 2022

Korean J Anesthesiol

View full text Add to dashboard Cite

Background: Remimazolam is a new ultrashort-acting benzodiazepine originally developed as an improved version of midazolam. Recent studies demonstrated non-inferiority of remimazolam to propofol in general anesthesia. However, to date, few studies have investigated the induction bolus dose of remimazolam required to achieve general anesthesia. We aimed to determine the 95% effective dose (ED 95 ) of remimazolam bolus that is required to achieve loss of consciousness (LOC) and the appropriate doses for different age groups.Methods: Patients aged 20-79 years with American Society of Anesthesiologists physical status of I or II were enrolled in this study. A total of 120 patients were included representing young, middle-aged, and elderly groups. Loss of eyelash reflex and verbal response after the administration of remimazolam was considered successful LOC. The ED 95 of remimazolam was determined using a biased coin up-and-down design with sequential allocation and the isotonic regression method. Results:The ED 95 of remimazolam for induction of general anesthesia was 0.37 mg/kg (95% confidence interval [CI]: 0.28-0.39) in the young group, 0.37 mg/kg (95% CI: 0.27-0.39) in the middle-aged group, and 0.25 mg/kg (95% CI: 0.2-0.29) in the elderly group. During the study period, none of the patients required rescue medications for hypotension or bradycardia. Conclusions:This study investigated the ED 95 of remimazolam bolus for anesthesia induction, and precise dosing of ED 95 can help maintain hemodynamic stability during induction.

show abstract

Section: Discussionmentioning

confidence: 99%

Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups

Park

Lee

et al. 2022

Korean J Anesthesiol

View full text Add to dashboard Cite

show abstract

“…38 Simulation of dexmedetomidine concentration in plasma and effect compartments using parameter estimates that use NFM 26 This dose prediction in the obese child appears at odds with that described clinically. The dexmedetomidine dose required as a 10-min infusion to achieve a minimum Ramsay sedation score of 4 or more 10 min after infusion was the same in both obese 39 However, a Ramsay score of four correlates approximately with a dexmedetomidine concentration of 1 µg.L −1 in a nonstimulatory environment. 3,40 Sedation was assessed 10 min after infusion (Ce 1.7, 2.0, 2.5 µg.L −1 ), and the methodology used a dichotomous effect measure such as a Ramsay score of four or more.…”

Section: Dos Ing In the Ob E S E Childmentioning

confidence: 84%

“…The larger central parameter 25.2 L.70 kg −1 described in children and adults, 26 when considered with its other pharmacokinetic parameters, describes both observed concentrations and effects. 31,39 Target concentration achievement requires a larger loading dose when dexmedetomidine is delivered by infusion, and this is reflected in the larger Vpe (Table 1) required for dose calculation. These principles also apply to intranasal dexmedetomidine administration.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetic concepts for dexmedetomidine target‐controlled infusion pumps in children

Morse

Cortínez

Anderson

2021

Pediatric Anesthesia

View full text Add to dashboard Cite

Dexmedetomidine is a drug with sedative, anxiolytic, sympatholytic, and analgesic properties that is finding widespread practice in pediatric anesthesia. 1 A concentration-response relationship for sedation has been described in adults. 4,2,3 Such knowledge could be incorporated into target-controlled infusion (TCI) pumps to develop closedloop systems for drug delivery. Open-loop rather than closed-loop TCI is the routine in pediatric anesthesia, although closed-loop systems have been described for propofol. 5,6 TCI pumps programmed for dexmedetomidine delivery are not yet commercially available for children. Their implementation will involve an understanding of dexmedetomidine parameters and covariate effects. The main covariates examined in drugs available for pediatric anesthesia are age, size, and fat mass.Extension of pharmacokinetic models and their parameter estimates using simulation can enrich understanding of drug behavior and serve as a basis for study design. 7 Simulation is particularly useful to demonstrate the practical implications of pharmacokinetics and parameter estimates at the start of the infusion (frontend kinetics) 8,9 and at the end of the infusion (back-end kinetics).These are times of changing drug concentration in plasma, and an

show abstract

“…1 μg/kg No differences in the dosage required for sedation in children suffering from obesity and those with normal weight [27]. Rolle et al have found in their study that lean body mass (LBM) is an appropriate dosing scalar for size in adult patients with obesity [18].…”

Section: Analgesics and Anestheticsmentioning

confidence: 99%

Drug dosing in children with obesity: a narrative updated review

et al. 2022

View full text Add to dashboard Cite

Childhood obesity and its associated comorbidities are highly prevalent diseases that may add to any other possible health problem commonly affecting the pediatric age. Uncertainties may arise concerning drug dosing when children with obesity need pharmacologic therapies. In general, in pediatric practice, there is a tendency to adapt drug doses to a child’s total body weight. However, this method does not consider the pharmacological impact that a specific drug can have under a two-fold point of view, that is, across various age and size groups as well. Moreover, there is a need for a therapeutic approach, as much as possible tailored considering relevant interacting aspects, such as modification in metabolomic profile, drug pharmacokinetics and pharmacodynamics. Taking into account the peculiar differences between children with overweight/obesity and those who are normal weight, the drug dosage in the case of obesity, cannot be empirically determined solely by the per kg criterion. In this narrative review, we examine the pros and cons of several drug dosing methods used when dealing with children who are affected also by obesity, focusing on specific aspects of some of the drugs most frequently prescribed in real-world practice by general pediatricians and pediatric subspecialists.

show abstract

Determination of the ED95 of a single bolus dose of dexmedetomidine for adequate sedation in obese or nonobese children and adolescents

Cited by 7 publications

References 35 publications

Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups

Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups

Pharmacokinetic concepts for dexmedetomidine target‐controlled infusion pumps in children

Drug dosing in children with obesity: a narrative updated review

Contact Info

Product

Resources

About