Recovery From Opioid Anesthesia: The Clinical Implication of Context-Sensitive Half-Times

Schraag, Stefan; Mohl, Ulrich; HIRSCH, MARTIN; Stolberg, Erhard; Georgieff, Michael

doi:10.1097/00132586-199902000-00014

Cited by 5 publications

(6 citation statements)

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“…However, the 50% decrease in drug concentration could not be specifically identified with clinical recovery end points. Later on, various context‐sensitive decrement times were proposed to describe the clinical data and to better predict recovery from anesthesia . This virtual effect‐site concentration is defined as the sum of normalized effect‐site concentrations of propofol and fentanyl, assuming an additive interaction between these drugs ( C P / C e50,P + C F / C e50,F ).…”

Section: Methodsmentioning

confidence: 99%

Pharmacokinetics and pharmacodynamics of propofol and fentanyl in patients undergoing abdominal aortic surgery – a study of pharmacodynamic drug–drug interactions

Wiczling

Bieda²,

Przybyłowski

et al. 2016

Biopharm & Drug Disp

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Propofol is routinely combined with opioid analgesics to ensure adequate anesthesia during surgery. The aim of the study was to assess the effect of fentanyl on the hypnotic effect of propofol and the possible clinical implications of this interaction. The pharmacokinetic/pharmacodynamic (PK/PD) data were obtained from 11 patients undergoing abdominal aortic surgery, classified as ASA III. Propofol was administered by a target-controlled infusion system. Fentanyl 2-3 µg/kg was given whenever insufficient analgesia occurred. The bispectral index (BIS) was used to monitor the depth of anesthesia. A population PK/PD analysis with a non-linear mixed-effect model (NONMEM 7.2 software) was conducted. Two-compartment models satisfactorily described the PK of propofol and fentanyl. The delay of the anesthetic effect in relation to PK was described by the effect compartment. The BIS was linked to propofol and fentanyl effect-site concentrations through an additive Emax model. Context-sensitive decrement times (CSDT) determined from the final model were used to assess the influence of fentanyl on the recovery after anesthesia. The population PK/PD model was successfully developed to describe simultaneously the time course and variability of propofol and fentanyl concentrations and BIS. Additive propofol-fentanyl interactions were observed and quantitated. The duration of the fentanyl infusion had minimal effect on CSDT when it was shorter than the duration of the propofol infusion. If the fentanyl infusion was longer than the propofol infusion, an almost two-fold increase in CSDT occurred. Additional doses of fentanyl administered after the cessation of the propofol infusion result in lower BIS values, and can prolong the time of recovery from anesthesia. Copyright © 2016 John Wiley & Sons, Ltd.

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Section: Methodsmentioning

confidence: 99%

Pharmacokinetics and pharmacodynamics of propofol and fentanyl in patients undergoing abdominal aortic surgery – a study of pharmacodynamic drug–drug interactions

Wiczling

Bieda²,

Przybyłowski

et al. 2016

Biopharm & Drug Disp

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“…67 Contributory factors to this problem include the fact that any selected infusion regimen is likely not to reliably yield a constant targeted plasma concentration. In addition, it is rather unlikely that recovery occurs at exactly 50% of the concentration at the end of the infusion.…”

Section: Pharmacologymentioning

confidence: 99%

Delayed Arousal

Anastasian

Ornstein

Heyer

2009

Anesthesiology Clinics

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Elderly patients have medical and psychological problems affecting all major organ systems. These problems may alter the pharmacokinetics and/or pharmacodynamics of medications, or expose previous neurologic deficits simply as a result of sedation. Delayed arousal, therefore, may arise from structural problems that are pre-existent or new, or metabolic or functional disorders such as convulsive or nonconvulsive seizures. Determining the cause of delayed arousal may require clinical, chemical, and structural tests. Structural problems that impair consciousness arise from a small number of focal lesions to specific areas of the central nervous system, or from pathology affecting the cerebrum. In general, focal or multifocal lesions can be identified by computerized tomography, or diffusion-weighted imaging. An algorithm is presented that outlines a workup for an elderly patient with delayed arousal.

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“…Günstige Eigenschaften der Narkosesteuerung von Seiten der Analgesie bei groûen Laparatomien wurde für Alfentanil TCI beschrieben [33], wohingegen mit Sufentanil TCI wegen der vergleichsweise langen ¾quilibrierungszeit (t 1 2 ke0 = 5,7 min) nur befriedigende Ergebnisse berichtet wurden [42]. [57].…”

Section: Tci Und Analgesieunclassified

Target Controlled Infusion (TCI) - Stellenwert und klinische Perspektiven

Schraag

Flaschar²,

Georgieff³

2000

Anästhesiol Intensivmed Notfallmed Schmerzther

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The technique of target controlled infusion (TCI) has influenced the development of intravenous anaesthesia substantially and opens the possibility of many new and exciting applications in peri-operative anaesthetic care. The launch of "Diprifusor" as the first commercially available TCI system for propofol was the cornerstone of a successful research period within the last decade, which evaluated the pharmacokinetic foundations of computer assisted intravenous drug delivery. We are now in a period where TCI technology is becoming a part of routine anaesthesia technique for the practitioner rather than a research tool for specialists and enthusiasts. This review gives an update on the rational pharmacokinetic basis of TCI development, the preliminary clinical experience with the new technique, the performance and accuracy of TCI devices and potential technical pitfalls in clinical routine. Besides clinical application in anaesthesia with "Diprifusor" TCI, target controlled systems are expected to play a significant role as research tools in the evaluation of drug interactions in anaesthesia and in the development of novel control techniques for the administration of sedative and analgesic drugs in the peri-operative period.

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Recovery From Opioid Anesthesia: The Clinical Implication of Context-Sensitive Half-Times

Cited by 5 publications

References 0 publications

Pharmacokinetics and pharmacodynamics of propofol and fentanyl in patients undergoing abdominal aortic surgery – a study of pharmacodynamic drug–drug interactions

Pharmacokinetics and pharmacodynamics of propofol and fentanyl in patients undergoing abdominal aortic surgery – a study of pharmacodynamic drug–drug interactions

Delayed Arousal

Target Controlled Infusion (TCI) - Stellenwert und klinische Perspektiven

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