Propofol pharmacokinetic and pharmacodynamic profile and its electroencephalographic interaction with remifentanil in children

Fuentes, Héctor R.; Cortínez, Luis Ignacio; Contreras, Víctor; Ibacache, Mauricio; Anderson, Brian J.

doi:10.1111/pan.13486

Cited by 25 publications

(23 citation statements)

References 33 publications

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“…Consequently, the slope parameter (Hill) estimate of 5.88 is less than that described by Eleveld (Hill = 9.05). Clearance increased over the first 6 months of life to reach mature values reported by others in children and adults . This model used only age and total body weight as covariates, ignoring any influence of fat mass.…”

Section: Discussionmentioning

confidence: 93%

“…Ninety percent of predictions fell within the range of 2.5‐5.5 µg.mL −1 , a target range commonly used in clinical anesthesia. We might anticipate effect site concentrations to be similar to those observed in plasma within 5 minutes of induction, given an effect site equilibration half‐time (T 1/2 keo) of 2.38 minutes reported for data included in this current pooled analysis.…”

Section: Discussionmentioning

confidence: 98%

“…Pediatric time‐concentration data were pooled from five sources: Allegaert and colleagues (n = 25, PMA 27‐43 weeks), Murat and colleagues (n = 12, age 1‐3 years) Kataria and colleagues (n = 53, age 3‐11 years), Feuntes and colleagues (n = 30, age 1‐12 years), and Sepulveda (n = 41, age 3‐26 months). These pooled data (1912 observations) were used for analysis.…”

Section: Methodsmentioning

confidence: 99%

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A manual propofol infusion regimen for neonates and infants

Morse

Hannam

Cortínez

et al. 2019

Pediatric Anesthesia

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Aims Manual propofol infusion regimens for neonates and infants have been determined from clinical observations in children under the age of 3 years undergoing anesthesia. We assessed the performance of these regimens using reported age‐specific pharmacokinetic parameters for propofol. Where performance was poor, we propose alternative dosing regimens. Methods Simulations using a reported general purpose pharmacokinetic propofol model were used to predict propofol blood plasma concentrations during manual infusion regimens recommended for children 0‐3 years. Simulated steady state concentrations were 6‐8 µg.mL−1 in the first 30 minutes that were not sustained during 100 minutes infusions. Pooled clinical data (n = 161, 1902 plasma concentrations) were used to determine an alternative pharmacokinetic parameter set for propofol using nonlinear mixed effects models. A new manual infusion regimen for propofol that achieves a steady‐state concentration of 3 µg.mL−1 was determined using a heuristic approach. Results A manual dosing regimen predicted to achieve steady‐state plasma concentration of 3 µg.mL−1 comprised a loading dose of 2 mg.kg−1 followed by an infusion rate of 9 mg.kg−1.h−1 for the first 15 minutes, 7 mg.kg−1.h−1 from 15 to 30 minutes, 6 mg.kg−1.h−1 from 30 to 60 minutes, 5 mg.kg−1.h−1 from 1 to 2 hours in neonates (38‐44 weeks postmenstrual age). Dose increased with age in those aged 1‐2 years with a loading dose of 2.5 mg.kg−1 followed by an infusion rate of 13 mg.kg−1.h−1 for the first 15 minutes, 12 mg.kg−1.h−1 from 15 to 30 minutes, 11 mg.kg−1.h−1 from 30 to 60 minutes, and 10 mg.kg−1.h−1 from 1 to 2 hours. Conclusion Propofol clearance increases throughout infancy to reach 92% that reported in adults (1.93 L.min.70 kg−1) by 6 months postnatal age and infusion regimens should reflect clearance maturation and be cognizant of adverse effects from concentrations greater than the target plasma concentration. Predicted concentrations using a published general purpose pharmacokinetic propofol model were similar to those determined using a new parameter set using richer neonatal and infant data.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

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A manual propofol infusion regimen for neonates and infants

Morse

Hannam

Cortínez

et al. 2019

Pediatric Anesthesia

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“…These properties make it a very useful adjunct for TIVA with propofol. Remifentanil exerts dose‐dependent synergistic anesthetic effects; hence, propofol requirements can be reduced . Another advantage of remifentanil for airway procedures will be its antitussive effect, which is dose‐dependent and helps prevent surgical complications such as bleeding, laryngospasm, and cardiovascular instability.…”

Section: What Are the Main Components Of Your Technique?mentioning

confidence: 99%

Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro‐con discussion

Lauder

Thomas

Ungern‐Sternberg

et al. 2020

Pediatric Anesthesia

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Anesthesia for pediatric airway procedures constitutes a true art form that requires training and experience. Communication between anesthetist and surgeon to establish procedure goals is essential in determining the most appropriate anesthetic management. But does the mode of anesthesia have an impact? Traditionally, inhalational anesthesia was the most common anesthesia technique used during airway surgery. Introduction of agents used for total intravenous anesthesia (TIVA) such as propofol, short‐acting opioids, midazolam, and dexmedetomidine has driven change in practice. Ongoing debates abound as to the advantages and disadvantages of volatile‐based anesthesia versus TIVA. This pro‐con discussion examines both volatiles and TIVA, from the perspective of effectiveness, safety, cost, and environmental impact, in an endeavor to justify which technique is the best specifically for pediatric airway procedures.

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“…The target range for anesthesia is 40‐60. Clonidine pharmacodynamic parameters were taken from Hayden et al, and propofol parameters were from Fuentes et al…”

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confidence: 99%