Remifentanil Dose/Electroencephalogram Bispectral Response During Combined Propofol/Regional Anesthesia

Koitabashi, Toshiya; Johansen, Jay W.; Sebel, Peter S.

doi:10.1097/00000539-200206000-00028

Cited by 47 publications

(37 citation statements)

References 12 publications

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“…This relevant reduction in propofol dose supports an interaction for this nociceptive stimulation, which agrees with previous studies in adults . Pharmacokinetic interactions between remifentanil and propofol should also be considered when interpreting clinical studies, since remifentanil administration, particularly when used in conjunction with a vasopressor, can cause a dose‐dependent decrease in cardiac output that can result in increased arterial and brain propofol concentrations, and consequent hypnotic effect . Current results in children confirmed remifentanil has little effect in BIS in children.…”

Section: Discussionsupporting

confidence: 87%

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

Fuentes

Cortínez

Contreras

et al. 2018

Pediatric Anesthesia

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Summary Background Propofol and remifentanil are commonly combined during total intravenous anesthesia. The impact of remifentanil in this relationship is poorly quantified in children. Derivation of an integrated pharmacokinetic and pharmacodynamic propofol model, containing remifentanil pharmacodynamic interaction information, enables propofol effect‐site target‐controlled infusion in children with a better prediction of its hypnotic effect when both drugs are combined. Aims We designed this study to derive an integrated propofol pharmacokinetic‐pharmacodynamic model in children and to describe the pharmacodynamic interaction between propofol and remifentanil on the electroencephalographic bispectral index effect. Methods Thirty children (mean age: 5.45 years, range 1.3‐11.9; mean weight: 23.5 kg, range 8.5‐61) scheduled for elective surgery with general anesthesia were studied. After sevoflurane induction, maintenance of anesthesia was based on propofol and remifentanil. Blood samples to measure propofol concentration were collected during anesthesia maintenance and up to 6 hours in the postoperative period. Bispectral index data were continuously recorded throughout the study. A pharmacokinetic‐pharmacodynamic model was developed using population modeling. The Greco model was used to examine the pharmacokinetic‐pharmacodynamic interaction between propofol and remifentanil for BIS response Results Propofol pharmacokinetic data from a previous study in 53 children were pooled with current data and simultaneously analyzed. Propofol pharmacokinetics were adequately described by a three‐compartment distribution model with first‐order elimination. Theory‐based allometric relationships based on TBW improved the model fit. The Greco model supported an additive interaction between propofol and remifentanil. Remifentanil showed only a minor effect in BIS response. Conclusion We have developed an integrated propofol pharmacokinetic‐pharmacodynamic model that can describe the pharmacodynamic interaction between propofol and remifentanil for BIS response. An additive interaction was supported by our modeling analysis.

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Section: Discussionsupporting

confidence: 87%

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

Fuentes

Cortínez

Contreras

et al. 2018

Pediatric Anesthesia

View full text Add to dashboard Cite

show abstract

“…31,32 Therefore, the nociceptive states of our participants might have differed enough to explain the inhomogeneity of the responses observed. Study was started after skin incision for all participants, but owing to the variation in types of procedures, level of stimulation might have varied throughout the 3 study periods.…”

Section: Nitrous-baselinementioning

confidence: 96%

Does Nitrous Oxide Affect Bispectral Index and State Entropy When Added to a Propofol Versus Sevoflurane Anesthetic?

Ozcan

Ozcan²,

Khan³

et al. 2010

Journal of Neurosurgical Anesthesiology

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“…After intubation, the amount of propofol required in each group to maintain BIS in the range of 40-60 decreased, and before incision, was closed to the initial concentration administered at induction of anesthesia. The potentiating effect of remifentanil likely accounts in part for the decreased propofol concentration 21,22…”

Section: Discussionmentioning

confidence: 99%

The Influence of the Severity of Chronic Virus-Related Liver Disease on Propofol Requirements during Propofol-Remifentanil Anesthesia

Huang

Chen

et al. 2013

Yonsei Med J

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PurposeThe purpose of this study was to investigate the influence of chronic virus-related liver disease severity on propofol requirements.Materials and MethodsIn this study, 48 male patients with chronic hepatitis B infection were divided into three groups according to Child-Turcotte-Pugh classification of liver function (groups A, B, and C with mild, moderate and severe liver disease, respectively). After intubation, propofol concentration was adjusted by ±0.3 µg/mL increments to maintain bispectral index in the range of 40-60. Target propofol concentrations at anesthesia initiation, pre-intubation and pre-incision were recorded.ResultsThe initial concentration used in group C was significantly lower than that used in group A or B (p<0.05), whereas no difference was observed between groups A and B. At pre-intubation, the actual required concentration of propofol increased significantly (3.2 µg/mL) in group A (p<0.05), which lead to significant differences between the groups (p<0.05). At pre-incision, the requirements for propofol decreased significantly in both groups A and B (3.0 µg/mL and 2.7 µg/mL, respectively) compared with those at pre-intubation (p<0.05), and were significantly different for all three groups (p<0.05), with group C demonstrating the lowest requirement (2.2 µg/mL). The required concentrations of propofol at pre-incision were similar to those at induction.ConclusionIn this study, propofol requirements administered by target-controlled infusion to maintain similar depths of hypnosis were shown to depend on the severity of chronic virus-related liver dysfunction. In other words, patients with the most severe liver dysfunction required the least amount of propofol.

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Remifentanil Dose/Electroencephalogram Bispectral Response During Combined Propofol/Regional Anesthesia

Cited by 47 publications

References 12 publications

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

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

Does Nitrous Oxide Affect Bispectral Index and State Entropy When Added to a Propofol Versus Sevoflurane Anesthetic?

The Influence of the Severity of Chronic Virus-Related Liver Disease on Propofol Requirements during Propofol-Remifentanil Anesthesia

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