Determination of the Pharmacodynamic Interaction of Propofol and Remifentanil during Esophagogastroduodenoscopy in Children

Abstract

A remifentanil infusion of 25 ng.kg(-1).min(-1) reduces the concentration of propofol required for adequate anesthesia for esophagogastroduodenoscopy from 3.7 to 2.8 microg/ml. Increasing the remifentanil infusion yields minimal additional decrease in propofol concentration and may increase the risk of side effects.

Intravenous Infusions for Sedation: Rationale, State of the Art, and Future Trends

“…Hammer and colleagues investigated the TCI propofol requirements for preventing a movement or hemodynamic response to esophagogastroduodenoscopy in 12 children between 3 and 11 years of age [55]. The EC50 (i.e., the propofol concentration estimated by the age-adjusted Kataria model at which 50 % of patients did not respond) in this group was 3.55 μ(mu)g/ mL when calculated using Dixon's up-down method [55] and 3.7 μ(mu)g/mL when recalculated using logistic regression [56]. In 45 children between 6 and 13 years of age, Rigouzzo found that the mean target propofol concentration (Kataria age-adjusted model) associated with a BIS (Bispectral Index) of 50 (i.e., surgical anesthesia) was 3.0 μ(mu)g/mL, and the mean measured propofol concentration associated with BIS 50 was 4.3 μ(mu)g/mL [43].…”

“…Drover studied the pharmacodynamic interaction of propofol and modest doses of remifentanil in children undergoing endoscopy and found that remifentanil reduced the target propofol concentration (Kataria age-adjusted model) required for tolerance of endoscopy from 3.7 to 2.8 μ(mu)g/mL [56].…”

Remifentanil and Other Opioids

“…This is probably related to the very rapid onset of effect the drug (Nieuwenhuijs et al 2003;Habib et al 2002;Dimitriou et al 2006;Lecomte et al 2006;Bilgin et al 2006;Chanavaz et al 2005;Locala et al 2005;Pleym et al 2004;Ouattara et al 2004;Godet et al 2004;Heijmans et al 2004;Joo et al 2004;Unlugenc et al 2003;Jellish et al 2003;Manyam et al 2006;Albertin et al 2006;Mustola et al 2005;Albertin et al 2004;Bouillon et al 2004;Kern et al 2004;Drover et al 2004;Mertens et al 2003;Milne et al 2003;Fechner et al 2003;Criado and Gomez e Segura 2003;Bothtner et al 2002).…”

“…Without opioid, the hypnotic concentration required for loss of consciousness is lower than the one to prevent response to noxious stimulations (around 1/3 MAC). It is moderately reduced by low-dose opioids: for example, propofol concentration for loss of consciousness is reduced by 25% in the presence of remifentanil 6 ng/ml (Nieuwenhuijs et al 2003;Manyam et al 2006;Albertin et al 2006;Mustola et al 2005;Albertin et al 2004;Bouillon et al 2004;Kern et al 2004;Drover et al 2004;Mertens et al 2003;Milne et al 2003;Fechner et al 2003;Criado and Gomez e Segura 2003;Bothtner et al 2002). Consequently, at high opioid concentrations the hypnotic needs for loss of consciousness may be higher than those to prevent response to noxious stimuli, and a patient might show no response to surgery and be completely awake, especially if he cannot move to signal his awareness because of neuromuscular blockade.…”

Simulated mid-ranging control of propofol and remifentanil using EEG-measured hypnotic depth of anesthesia

“…No similar study has been conducted in children, but the interaction has been reported [19]. This work therefore adopts the values α = 5.1 and C r e,50 = 12.5 ng/ml from [18], while using the γ values of the 23 identified models.…”