Sevoflurane Remifentanil Interaction

Heyse, Björn; Proost, Johannes H.; Schumacher, Peter; Bouillon, Thomas; Vereecke, Hugo; Eleveld, Douglas J.; Luginbühl, Martin; Struys, Michel

doi:10.1097/aln.0b013e318242a2ec

Cited by 50 publications

(10 citation statements)

References 19 publications

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“…1, 2, 4 and 8 ng⋅ml −1 for groups A, B, C and D, respectively. The corresponding Ce PROP resulting in P TOL = 90% was obtained from the sigmoidal response function for a dichotomous effect [ 2 , 9 , 10 ]. where γ is the slope parameter, representing the steepness of the concentration-effect relationship, and U is the combined potency of the drugs according to where Ce50 PROP is the effect-site concentration of propofol resulting in P TOL = 0.5 if given alone, and Ce50 REMI is the Ce REMI that results in an increase of U by a factor 2 or an apparent decrease of Ce50 PROP by 50%.…”

Section: Methodsmentioning

confidence: 99%

Comparison of haemodynamic- and electroencephalographic-monitored effects evoked by four combinations of effect-site concentrations of propofol and remifentanil, yielding a predicted tolerance to laryngoscopy of 90%

Berg

Absalom

Venema

et al. 2020

J Clin Monit Comput

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This prospective study evaluates haemodynamic and electroencephalographic effects observed when administering four combinations of effect-site concentrations of propofol (Ce PROP) and remifentanil (Ce REMI), all yielding a single predicted probability of tolerance of laryngoscopy of 90% (P TOL = 90%) according to the Bouillon interaction model. We aimed to identify combinations of Ce PROP and Ce REMI along a single isobole of P TOL that result in favourable hypnotic and haemodynamic conditions. This knowledge could be of advantage in the development of drug advisory monitoring technology. 80 patients (18-90 years of age, ASA I-III) were randomized into four groups and titrated towards Ce PROP (Schnider model, ug⋅ml −1) and Ce REMI (Minto model, ng⋅ml −1) of respectively 8.6 and 1, 5.9 and 2, 3.6 and 4 and 2.0 and 8. After eleven minutes of equilibration, baseline measurements of haemodynamic endpoints and bispectral index were compared with three minutes of responsiveness measurements after laryngoscopy. Before laryngoscopy, bispectral index differed significantly (p < 0.0001) between groups in concordance with Ce PROP. Heart rate decreased with increasing Ce REMI (p = 0.001). The haemodynamic and arousal responses evoked by laryngoscopy were not significantly different between groups, but Ce PROP = 3.6 μg⋅ml −1 and Ce REMI = 4 ng⋅ml −1 evoked the lowest median value for ∆HR and ∆SAP after laryngoscopy. This study provides clinical insight on the haemodynamic and hypnotic consequences, when a model based predicted P TOL is used as a target for combined effect-site controlled target-controlled infusion of propofol and remifentanil. Heart rate and bispectral index were significantly different between groups despite a theoretical equipotency for P TOL , suggesting that each component of the anaesthetic state (immobility, analgesia, and hypnotic drug effect) should be considered as independent neurophysiological and pharmacological phenomena. However, claims of (in)accuracy of the predicted P TOL must be considered preliminary because larger numbers of observations are required for that goal.

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Section: Methodsmentioning

confidence: 99%

Comparison of haemodynamic- and electroencephalographic-monitored effects evoked by four combinations of effect-site concentrations of propofol and remifentanil, yielding a predicted tolerance to laryngoscopy of 90%

Berg

Absalom

Venema

et al. 2020

J Clin Monit Comput

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“…Sufentanil and remifentanil are opioid receptor agonists with a great analgesic effect during surgery ( 6 – 11 ). However, there are few comparative studies available on the application of the two agonists in the laparoscopic radical resection of colorectal cancer with TCI.…”

Section: Introductionmentioning

confidence: 99%

Comparison of recovery effect for sufentanil and remifentanil anesthesia with TCI in laparoscopic radical resection during colorectal cancer

Yao

Zhang

et al. 2016

Oncology Letters

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The aim of the present study was to compare the recovery of sufentanil and remifentanil anesthesia by target-controlled infusion (TCI) in elderly patients with laparoscopic-assisted radical resection of colorectal cancer. The effect of anesthesia on patient stress response and cellular immune function was also observed. Elderly patients (n=192) who underwent laparoscopic radical resection of colorectal cancer between July 2014 and October 2015 were randomly divided into the sufentanil and remifentanil groups (n=96 per group). The two groups used sufentanil- and remifentanil-based anesthesia by TCI. The wake-up time, extubation time, orientation recovery time, vital signs, stress response, distribution of T-cell subsets and incidence of adverse reactions were recorded and compared. The wake-up and extubation times of the remifentanil group were significantly shorter than those of the sufentanil group. The difference of orientation recovery time was not statistically significant. The differences in heart rate, mean arterial pressure, and arterial oxygen saturation following anesthesia and during surgery and those prior to anesthesia of the sufentanil group were not statistically significant. However, those of the remifentanil group significantly improved following anesthesia. The concentrations of glucose, cortisol (COR), and interleukin-6 and C-reactive protein were stable in the sufentanil group, whereas the indices in the remifentanil group had a tendency of increasing during the anesthesia and surgery, and had a longer postoperative recovery time. The decreasing degree of T-cell subsets in the sufentanil group was significantly lower than that in the remifentanil group, and had a short recovery of cellular immunity following surgery. The adverse reactions rate during anesthesia of the remifentanil group was significantly higher than that of the sufentanil group. In conclusion, sufentanil- and remifentanil-based anesthesia with TCI has certain advantages, including improved recovery effect, less stress response, less inhibition of cellular immunity and fewer adverse reactions. It has the potential to become the first choice of anesthetic in the clinic for elderly patients who undergo laparoscopic radical resection for colorectal cancer.

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“…Regarding the Minto interaction term β, Diz et al [ 14 ] reported it as a positive number of 0.424; however, they only concluded that additivity exists because the β value did not differ significantly from the value of 0 due to its wide confidence interval. Heyse et al [ 16 ] reported the interaction term β between sevoflurane and remifentanil as 1.47, which turned to be significant.…”

Section: Discussionmentioning

confidence: 99%

Synergism between rocuronium and cisatracurium: comparison of the Minto and Greco interaction models

Jeon

Kwon

Kim

et al. 2016

Korean J Anesthesiol

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BackgroundThis study was conducted to investigate the pharmacodynamic interaction between rocuronium and cisatracurium using the response surface model, which is not subject to the limitations of traditional isobolographic analysis.MethodsOne hundred and twenty patients were randomly allocated to receive one of the fifteen predefined combinations of rocuronium and cisatracurium. To study single drugs, cisatracurium 0.2, 0.15, or 0.1 mg/kg or rocuronium 0.8, 0.6 or 0.4 mg/kg doses were administered alone. To study the pharmacodynamic interaction, drugs were applied in three types of combination ratio, i.e., half dose of each drug alone, 75% of each single dose of rocuronium and 25% of each single dose of cisatracurium, and vice versa. Train-of-four (TOF) ratio and T1% (first twitch of the TOF presented as percentage compared to the initial T1) were used as pharmacodynamic endpoints, and the Greco and Minto models were used as surface interaction models.ResultsThe interaction term α of the Greco model for TOF ratio and T1% measurements showed synergism with values of 0.977 and 1.12, respectively. Application of the Minto model resulted in U50 (θ) values (normalized unit of concentration that produces 50% of the maximal effect in the 0 < θ < 1 region) less than 1 for both TOF ratio and T1% measurements, indicating that rocuronium and cisatracurium exhibit synergism.ConclusionsResponse surface modeling of the interaction between rocuronium and cisatracurium, based on considerations of their effects on muscle relaxation as measured by TOF ratio and T1%, indicated that the two drugs show considerable synergism.

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Sevoflurane Remifentanil Interaction

Cited by 50 publications

References 19 publications

Comparison of haemodynamic- and electroencephalographic-monitored effects evoked by four combinations of effect-site concentrations of propofol and remifentanil, yielding a predicted tolerance to laryngoscopy of 90%

Comparison of haemodynamic- and electroencephalographic-monitored effects evoked by four combinations of effect-site concentrations of propofol and remifentanil, yielding a predicted tolerance to laryngoscopy of 90%

Comparison of recovery effect for sufentanil and remifentanil anesthesia with TCI in laparoscopic radical resection during colorectal cancer

Synergism between rocuronium and cisatracurium: comparison of the Minto and Greco interaction models

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