Pharmacokinetic Model Driven Infusion of Propofol in Children

Marsh, Bret; White, Martin; Morton, Neil S.; Kenny, G. N. C.

doi:10.1093/bja/67.1.41

Cited by 1,048 publications

(724 citation statements)

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“…A depuração do propofol também está aumentada em pacientes pediátricos. Marsh 13 mostrou em crianças uma depuração com valores entre 32 a 57 ml.kg -1 .min -1 . Nos pacientes adultos este parâmetro foi em média de 27 ml.kg -1 .min -1 .…”

Section: Discussionunclassified

“…Esta complementação foi mí-nima e se resumiu a quatro pacientes do grupo S e a 5 do grupo M. Isto demonstra a eficácia da analgesia do N 2 O a 60% associado ao propofol. Neste estudo, utilizou-se, de modo original, atributos farmacocinéticos obtidos de duas pesquisas realizadas em crianças nas faixas etárias de 4 a 12 anos 13,14 . Para uso destes parâmetros farmacocinéticos empregou-se "software" (PROCRIV, PROCHIV) baseado no estudo realizado por Bailey 9 propondo método simplificado para manter a concentração sangüínea em níveis aproximadamente constantes.…”

Section: Discussionunclassified

“…Com isso, ele descreveu teoricamente uma técnica para o cálculo do ritmo de infusões seqüenciais necessárias para se aproximar do nível sangüíneo constante. Este método foi adaptado por Vianna [10][11][12] , para uso do propofol em infusão contínua 11 , utilizando-se os atributos farmacocinéticos obtidos por Marsh 13 e por Short 14 , tendo como objetivo popularizar o uso da concentração-alvo controlada, ou seja, a manutenção das concentrações sangüíneas desejadas em níveis aproximadamente constantes. Afinalidade desta pesquisa é comparar clínica e laboratorialmente os atributos farmacocinéticos de Marsh 13 e Short 14 , usados para controle-alvo do propofol associado ao óxido nitroso, em crianças com idades entre 4 e 12 anos.…”

Section: Introductionunclassified

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Método simplificado para manutenção da concentração sangüínea de propofol em nível aproximadamente constante, associado ao óxido nitroso no paciente pediátrico

Vianna¹,

Vilela²,

Cordon³

et al. 2002

Rev. Bras. Anestesiol.

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Section: Discussionunclassified

Section: Introductionunclassified

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Método simplificado para manutenção da concentração sangüínea de propofol em nível aproximadamente constante, associado ao óxido nitroso no paciente pediátrico

Vianna¹,

Vilela²,

Cordon³

et al. 2002

Rev. Bras. Anestesiol.

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“…Pupil assessments were executed before surgery. Anaesthesia was induced with propofol (propolipid 1%) by target controlled infusion (TCI; Marsh‐model; injectomat TIVA Agilia, Fresenius Kabi, Germany),16, 17 and the target effect‐site concentration (Ce) was progressively increased until loss of consciousness (LOC). The sedation depth (SeD) ranged from 40 to 50 on the sedation depth brain monitor NeuroSense ® (NeuroWave Systems Inc., Cleveland, OH).…”

Section: Methodsmentioning

confidence: 99%

Pain assessment by pupil dilation reflex in response to noxious stimulation in anaesthetized adults

Wildemeersch

Peeters

Saldien

et al. 2018

Acta Anaesthesiol Scand

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BackgroundIn response to noxious stimulation, pupillary dilation reflex (PDR) occurs even in anaesthetized patients. The aim of the study was to evaluate the ability of pupillometry with an automated increasing stimulus intensity to monitor intraoperative opioid administration.MethodsThirty‐four patients undergoing elective surgery were enrolled. Induction by propofol anaesthesia was increased progressively until the sedation depth criteria (SeD) were attained. Subsequently, a first dynamic pupil measurement was performed by applying standardized nociceptive stimulation (SNS). A second PDR evaluation was performed when remifentanil reached a target effect‐site concentration. Automated infrared pupillometry was used to determine PDR during nociceptive stimulations generating a unique pupillary pain index (PPI). Vital signs were measured.ResultsAfter opioid administration, anaesthetized patients required a higher stimulation intensity (57.43 mA vs 32.29 mA, P < .0005). Pupil variation in response to the nociceptive stimulations was significantly reduced after opioid administration (8 mm vs 28 mm, P < .0005). The PPI score decreased after analgesic treatment (8 vs 2, P < .0005), corresponding to a 30% decrease. The elicitation of PDR by nociceptive stimulation was performed without changes in vital signs before (HR 76 vs 74/min, P = .09; SBP 123 vs 113 mm Hg, P = .001) and after opioid administration (HR 63 vs 62/min, P = .4; SBP 98.66 vs 93.77 mm Hg, P = .032).ConclusionsDuring propofol anaesthesia, pupillometry with the possibility of low‐intensity standardized noxious stimulation via PPI protocol can be used for PDR assessment in response to remifentanil administration.

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“…Induction of anaesthesia was conducted using a target-controlled infusion system (STEL-TCI, controlling a Harvard-22 syringe pump via a RS232 serial cable) (STEL-TCI: A targetcontrolled infusion system that is included in the STELPUMP suite of pharmacokinetic programs 2003: Authors JF Coetzee and P de Kock, Stellenbosch University.) The plasma site (central compartment) was targeted at a concentration of 6 g.ml -1 , employing the pharmacokinetic parameters of Marsh et al 6 LOC was regarded as the moment at which the patient could not keep her eyes open and was confirmed by the absence of an eyelash reflex, and loss of verbal contact. At this point Propofol administration was discontinued and data were recorded for a further two minutes, as described below.…”

Section: Methodsmentioning

confidence: 99%

A comparison of induction of anaesthesia using two different propofol preparations

Terblanche

Coetzee

2008

Southern African Journal of Anaesthesia and Analgesia

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Background: Investigators have reported inter-patient variability with regard to propofol dosage for induction of anesthesia, since early dose finding studies. With the arrival of generic formulations of propofol, questions have arisen regarding further variability in dose requirements. Various studies have confirmed that generic propofol preparations are pharmacokinetically and pharmacodynamically equivalent to Diprivan ® . Nevertheless a number of practitioners are under the impression that certain generic propofol preparations require greater doses for induction of anaesthesia than does Diprivan ® .Methods: 20 female patients of ASA status I-II, between the ages of 18-55 years, scheduled for routine surgery were randomly allocated to two groups to undergo induction of anaesthesia using two different propofol formulations; Diprivan ® and Propofol 1% Fresenius ® . Either preparation was administered using a target-controlled infusion of propofol (STEL-TCI) targeting the plasma (central) compartment at a concentration of 6 g.ml -1 , employing the pharmacokinetic parameters of Marsh et al. A processed EEG (bispectral index) was continuously recorded. Loss of consciousness (LOC) was regarded as the moment at which the patient could not keep her eyes open and was confirmed by the absence of an eyelash reflex. At this point propofol administration was discontinued and data were recorded for a further two minutes, before administering an appropriate opioid and/or nitrous oxide/volatile agent and/or muscle relaxant to maintain anaesthesia. Time to LOC after start of propofol administration, and the dose of propofol administered during induction were annotated.Results: There were no demographic differences between the groups. There were no differences between the groups with regard to the mean dose for LOC, time to LOC and to the mean BIS values obtained at the following stages: awake, at LOC, at 1 and 2 minutes after LOC as well as the lowest recorded value. Conclusions:Our results confirm that the two propofol formulations that we studied, are pharmacologically equivalent with regard to induction of anaesthesia. Other mechanisms can explain the variability in clinical response to bolus administration of propofol. The most important is the recirculatory or "front-end" kinetics of propofol in which cardiac output plays a major role, as well as the rate of drug administration. Emulsion degradation can also influence dose-response and in this regard it should be noted that the addition of foreign substances such as lignocaine, can result in rapid deterioration of the soyabean emulsion.

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Pharmacokinetic Model Driven Infusion of Propofol in Children

Cited by 1,048 publications

References 10 publications

Método simplificado para manutenção da concentração sangüínea de propofol em nível aproximadamente constante, associado ao óxido nitroso no paciente pediátrico

Método simplificado para manutenção da concentração sangüínea de propofol em nível aproximadamente constante, associado ao óxido nitroso no paciente pediátrico

Pain assessment by pupil dilation reflex in response to noxious stimulation in anaesthetized adults

A comparison of induction of anaesthesia using two different propofol preparations

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