Pharmacokinetic and pharmacodynamic interactions in anaesthesia. A review of current knowledge and how it can be used to optimize anaesthetic drug administration

Berg, Johannes P van den; Vereecke, Hugo; Proost, Johannes H.; Eleveld, Douglas J.; Wietasch, G.; Absalom, Anthony; Struys, Michel

doi:10.1093/bja/aew312

Cited by 55 publications

(40 citation statements)

References 130 publications

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“…Besides biomarkers for pain detection under general anesthesia [16], modelling of physiological nociception and drug pharmacokinetics/pharmacodynamics (PK/PD) have a significant impact on anesthesia drug administration [39,40]. The performance of the traditional target-controlled infusion systems for anesthesia can be improved by the real-time adaptation of PK/PD models [41][42][43].…”

Section: Discussionmentioning

confidence: 99%

Pain Detection with Bioimpedance Methodology from 3-Dimensional Exploration of Nociception in a Postoperative Observational Trial

Neckebroek

Ghita

et al. 2020

JCM

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Although the measurement of dielectric properties of the skin is a long-known tool for assessing the changes caused by nociception, the frequency modulated response has not been considered yet. However, for a rigorous characterization of the biological tissue during noxious stimulation, the bioimpedance needs to be analyzed over time as well as over frequency. The 3-dimensional analysis of nociception, including bioimpedance, time, and frequency changes, is provided by ANSPEC-PRO device. The objective of this observational trial is the validation of the new pain monitor, named as ANSPEC-PRO. After ethics committee approval and informed consent, 26 patients were monitored during the postoperative recovery period: 13 patients with the in-house developed prototype ANSPEC-PRO and 13 with the commercial device MEDSTORM. At every 7 min, the pain intensity was measured using the index of Anspec-pro or Medstorm and the 0–10 numeric rating scale (NRS), pre-surgery for 14 min and post-anesthesia for 140 min. Non-significant differences were reported for specificity-sensitivity analysis between ANSPEC-PRO (AUC = 0.49) and MEDSTORM (AUC = 0.52) measured indexes. A statistically significant positive linear relationship was observed between Anspec-pro index and NRS (r2 = 0.15, p < 0.01). Hence, we have obtained a validation of the prototype Anspec-pro which performs equally well as the commercial device under similar conditions.

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Section: Discussionmentioning

confidence: 99%

Pain Detection with Bioimpedance Methodology from 3-Dimensional Exploration of Nociception in a Postoperative Observational Trial

Neckebroek

Ghita

et al. 2020

JCM

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“…Our low end-tidal anaesthetic concentrations and the low mean propofol dosage may be explained by the remifentanil dose we used. 43 As recommended by the ASA guideline, we monitored the depth of anaesthesia using clinical techniques and conventional monitoring systems. 44 We used BIS monitoring as a surrogate indicator of the hypnotic drug effect to enhance the comparability of anaesthesia depth across the groups.…”

Section: Discussionmentioning

confidence: 99%

“… 44 We used BIS monitoring as a surrogate indicator of the hypnotic drug effect to enhance the comparability of anaesthesia depth across the groups. 43 Previous studies have shown a significant lack of homogeneity with regard to the anaesthetics used, and to the best of our knowledge, only one study utilised BIS monitoring. 5 A rapid induction with high desflurane concentrations was avoided because this may enhance the risk of increased inspiratory resistance and consequent upper airway complications.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we cannot conclude that anaesthetic exposure was equipotent in the three groups. However, BIS is one of the most widely used brain electrical activity monitors in clinical practice, 43 , 44 and we did our best to achieve relatively equipotent anaesthesia depth in this study, which was performed during routine clinical practice. However, patients vary and an array of individual variables may influence the effects of anaesthetics on the depth of anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

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Emergence times and airway reactions during general anaesthesia with remifentanil and a laryngeal mask airway

Kowark

Rossaint

Pühringer

et al. 2018

European Journal of Anaesthesiology

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BACKGROUNDAvoidance of airway complications and rapid emergence from anaesthesia are indispensable for the use of a laryngeal mask airway (LMA). Evidence from adequately powered randomised studies with a low risk of bias for the optimal anaesthetic in this context is limited.OBJECTIVEWe tested the hypothesis that when using remifentanil-based intra-operative analgesia, desflurane would be the most suitable anaesthetic: with noninferiority in the occurrence of upper airway complications and superiority in emergence times compared with sevoflurane or propofol.DESIGNA randomised, multicentre, partially double-blinded, three-arm, parallel-group study.SETTINGTwo university and two regional German hospitals, from February to October 2015.PATIENTSA total of 352 patients (age 18 to 75 years, ASA physical status I to III, BMI less than 35 kg m−2 and fluent in German) were enrolled in this study. All surgery was elective with a duration of 0.5 to 2 h, and general anaesthesia with a LMA was feasible.INTERVENTIONThe patients were randomised to receive desflurane, sevoflurane or propofol anaesthesia.MAIN OUTCOME MEASURESThis study was powered for the primary outcome ‘time to state date of birth’ and the secondary outcome ‘intra-operative cough’. Time to emergence from anaesthesia and the incidence of upper airway complications were assessed on the day of surgery.RESULTSThe primary outcome was analysed for 343 patients: desflurane (n=114), sevoflurane (n=111) and propofol (n=118). The desflurane group had the fastest emergence. The mean (± SD) times to state the date of birth following desflurane, sevoflurane and propofol were 8.1 ± 3.6, 10.1 ± 4.0 and 9.8 ± 5.1 min, respectively (P < 0.01). There was no difference in upper airway complications (cough and laryngospasm) across the groups, but these complications were less frequent than in previous studies.CONCLUSIONWhen using a remifentanil infusion for intra-operative analgesia in association with a LMA, desflurane was associated with a significantly faster emergence and noninferiority in the incidence of intra-operative cough than either sevoflurane or Propofol.TRIAL REGISTRATIONClinicalTrials.gov identifier: NCT02322502; EudraCT identifier: 2014-003810-96.

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“…An increasing number of publications deal with the use of dexmedetomidine mainly in the pediatric intensive care unit population—in particular for sedation in hemodynamically unstable patients, such as postcardiac surgery. A recent review of the use of dexmedetomidine in the pediatric population showed that evidence favoring dexmedetomidine in children is mainly extrapolated based on adult studies, small randomized controlled trials, and observational studies . Pediatric trials are therefore needed, with a specific focus on newborns and infants, taking into account the major side effects documented in the literature for dexmedetomidine, hypotension and bradycardia, for which continuous cardiac monitoring is needed.…”

Section: Dose Determination Of Common Analgosedative Drugsmentioning

confidence: 99%

Analgesics and Sedatives in Critically Ill Newborns and Infants: The Impact on Long‐Term Neurodevelopment

Schiller

Allegaert

Hunfeld

et al. 2018

The Journal of Clinical Pharma

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Inadequate pain and/or stress management in preterm‐ and term‐born infants has been associated with increased morbidity and even mortality. However, exposure to analgosedatives during early infancy may also be one of the risk factors for subsequent neurodevelopmental impairment, at least in animal studies. Because infants admitted to neonatal or pediatric intensive care units may receive high amounts of these drugs for prolonged periods of time and the majority of these infants nowadays survive to discharge, this is of major concern. A balanced approach that incorporates the assessment and quantification of both wanted effects as well as unwanted side effects is therefore needed. In this article, the optimal dose determination of commonly used analgosedative drugs as well as their potential long‐term effects on the developing human brain and neuropsychological functioning are reviewed.

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Pharmacokinetic and pharmacodynamic interactions in anaesthesia. A review of current knowledge and how it can be used to optimize anaesthetic drug administration

Cited by 55 publications

References 130 publications

Pain Detection with Bioimpedance Methodology from 3-Dimensional Exploration of Nociception in a Postoperative Observational Trial

Pain Detection with Bioimpedance Methodology from 3-Dimensional Exploration of Nociception in a Postoperative Observational Trial

Emergence times and airway reactions during general anaesthesia with remifentanil and a laryngeal mask airway

Analgesics and Sedatives in Critically Ill Newborns and Infants: The Impact on Long‐Term Neurodevelopment

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