Electroencephalographic response following midazolam-induced general anesthesia: relationship to plasma and effect-site midazolam concentrations

Miyake, Wakako; Oda, Yutaka; Ikeda, Yoichi; Hagihira, Satoshi; Iwaki, Hiroaki; Asada, Akira

doi:10.1007/s00540-010-0907-4

Cited by 33 publications

(37 citation statements)

References 23 publications

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“…Miyake et al [ 32 ] investigated the correlation between serum concentration of midazolam and BIS index in 24 orthopedic patients (ASA I/II). Patients were separated in a small dose (0.2 mg kg −1 ) and a large dose midazolam group (0.3 mg kg −1 ).…”

Section: Discussionmentioning

confidence: 99%

Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients

et al. 2018

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BackgroundAnalgosedation is a cornerstone therapy for mechanically ventilated patients in intensive care units (ICU). To avoid inadequate sedation and its complications, monitoring of analgosedation is of great importance. The aim of this study was to investigate whether monitoring of analgosedative drug concentrations (midazolam and sufentanil) might be beneficial to optimize analgosedation and whether drug serum concentrations correlate with the results of subjective (Richmond Agitation-Sedation Scale [RASS]/Ramsay Sedation Scale) and objective (bispectral (BIS) index) monitoring procedures.MethodsForty-nine intubated, ventilated, and analgosedated critically ill patients treated in ICU were clinically evaluated concerning the depth of sedation using RASS Score, Ramsay Score, and BIS index twice a day. Serum concentrations of midazolam and sufentanil were determined in blood samples drawn at the same time. Clinical and laboratory data were statistically analyzed for correlations using the Spearman’s rank correlation coefficient rho (ρ).ResultsAverage age of the population was 57.8 ± 16.0 years, 61% of the patients were males. Most frequent causes for ICU treatments were sepsis (22%), pneumonia (22%), or a combination of both (25%). Serum concentrations of midazolam correlated weakly with RASS (ρ = − 0.467) and Ramsay Scores (ρ = 0.476). Serum concentrations of sufentanil correlated weakly with RASS (ρ = − 0.312) and Ramsay Scores (ρ = 0.295). Correlations between BIS index and serum concentrations of midazolam (ρ = − 0.252) and sufentanil (ρ = − 0.166) were low.ConclusionCorrelations between drug serum concentrations and clinical or neurophysiological monitoring procedures were weak. This might be due to intersubject variability, polypharmacy with drug-drug interactions, and complex metabolism, which can be altered in critically ill patients. Therapeutic drug monitoring is not beneficial to determine depth of sedation in ICU patients.Electronic supplementary materialThe online version of this article (10.1186/s40560-018-0331-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients

et al. 2018

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“…Neural dynamics and synchronization of brain signals have been increasingly recognized to be an important mechanism to measure coordination of brain regions (Singer 2001;Xie 2010). Synchronous oscillations between different regions may be useful correlates of brain function, and their changes have been used for instance in the study of cognitive processes and depth of anesthesia (Basar et al 2001;Ferenets et al 2006;Miyake et al 2010), drug effects (Fingelkurts et al 2009;Alonso et al 2010;Minc et al 2010), pathologies directly related to cerebral activity (Jeong et al 2001;Stam 2005;Srinivasan et al 2007;Alonso et al 2011), and other diseases (Tong et al 2003;Shin et al 2006). Nonlinear techniques, mainly based on generalized and phase synchronization measures, have lately been used to quantify nonlinear interactions in neurophysiology (David et al 2004;Pereda et al 2005;Stam 2005;Stam et al 2009;Kreuz et al 2007; Montez et al 2009;Wendling et al 2009).…”

Section: Introductionmentioning

confidence: 99%

Cross-conditional entropy and coherence analysis of pharmaco-EEG changes induced by alprazolam

et al. 2011

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“…It has been reported that midazolam reduced BIS values depending on the degree of sedation. Sedation during regional anesthesia could be managed with midazolam at BIS values around 75 [5]. General anesthesia could be induced with intravenous bolus injection of midazolam 0.2-0.3 mg/kg, resulting in BIS values between 60 and 70 [6].…”

Section: Discussionmentioning

confidence: 99%

Use of bispectral index monitoring for a patient with hepatic encephalopathy requiring living donor liver transplantation: a case report

et al. 2010

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We report the use of perioperative bispectral index (BIS) monitoring in a patient who underwent living donor liver transplantation (LDLT). Hepatic encephalopathy featuring extreme excitement developed in a 42-year-old male and was diagnosed as acute hepatitis. Sedation with continuous infusion of midazolam was necessary. BIS value gradually decreased and reached 0 17 h after commencement of continuous infusion of midazolam. Midazolam infusion was stopped but BIS value remained 0. Brain CT scan revealed an almost normal image. Multi-lead electroencephalogram was recorded revealing almost no electrical activity. Administration of flumazenil did not improve his consciousness and BIS value. Adequate spontaneous respiration was maintained and the possibility of brain death was excluded. LDLT was performed on the 5th ICU day. BIS value remained 0 throughout surgery. BIS value suddenly increased 2 h after surgery and reached 60 11 h after surgery. It became possible to communicate with the patient and his trachea was extubated on the 4th postoperative day. We believe that, with BIS, we were able to follow preoperative exacerbation of the "pathological" process of hepatic encephalopathy, and predict postoperative emergence from general anesthesia, suggesting normal graft function.

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Electroencephalographic response following midazolam-induced general anesthesia: relationship to plasma and effect-site midazolam concentrations

Cited by 33 publications

References 23 publications

Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients

Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? A prospective observation study of medical intensive care patients

Cross-conditional entropy and coherence analysis of pharmaco-EEG changes induced by alprazolam

Use of bispectral index monitoring for a patient with hepatic encephalopathy requiring living donor liver transplantation: a case report

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