Slower administration of propofol preserves adequate respiration in children

Narcotrend Index guidance of propofol delivery for deep sedation in children aged 12-17 years, underdoing gastrointestinal endoscopy results in faster recovery, less drug consumption, and fewer episodes of oversedation than dosing propofol according to clinical surrogate parameters of depth of hypnosis. The results of this study provide additional evidence in favor of the safety profile of propofol/remifentanil for procedural sedation in adequately selected pediatric patients.

Section: Discussionmentioning

confidence: 99%

The impact of Narcotrend™ EEG‐guided propofol administration on the speed of recovery from pediatric procedural sedation—A randomized controlled trial

Weber

Walhout

Escher

2018

“…Examples of BCD in anesthesia studies include identifying the minimum effective dose of lidocaine or ropivacaine needed to effectively block the femoral nerve in 90% of subjects. Pediatric anesthesia examples include determining the speed of a propofol bolus at induction preserving respiration , finding an ED 95 dose of remifentanil allowing extubation without coughing post tonsillectomy , or determining the effect of obesity on ED 95 for propofol during induction .…”

Section: Sequential Design Methodsmentioning

confidence: 99%

Sequential allocation trial design in anesthesia: an introduction to methods, modeling, and clinical applications

Görges

Zhou

Brant

et al. 2017

Self Cite

Summary Estimation of the dose–response curve for new anesthetic protocols typically focuses on identifying minimum effective doses. The application of a sequential experimental method is appropriate, as it minimizes sample size requirements by updating dose assignments based on information accrued from successive subjects. One approach is the up‐and‐down method for estimating the median effective dose in a patient population (ED50). Designs better suited for achieving greater than 50% effectiveness, include the biased coin approach, and continual reassessment method. In this review we introduce different sequential design methods, provide examples of their use, and show through simulation how the method employed influences sample size and the accuracy of the estimated dose. Simulation studies are presented to illustrate the effects of dose parameter and stopping rule choice for up‐and‐down method and biased coin approach. For continual reassessment method, the effects of assumed dose–response model, prior guess, and cohort size are simulated. A binary response regression curve was fit to the data in Saidman and Eger's endtidal halothane dose‐finding study to provide a dose–response curve for generating simulations. A range of options exist when designing a study using sequential allocation with biased coin approach or continual reassessment method. Method choice influences the required sample size and confidence in estimated effect. In the halothane example, up‐and‐down method decreases the required sample size by 20–30% when the choice of design parameters is optimal. For both up‐and‐down method and biased coin approach designs, greater sample sizes, arising from adjusted stopping criteria, might be required to achieve reliable estimates. The continual reassessment method is only efficient if a limited range of doses can be chosen a priori. In conclusion the up‐and‐down method can be more efficient than nonsequential designs for the estimation of the median dose/intervention level for a given intervention (ED50). The biased coin approach or continual reassessment method are preferred for the estimation of higher or lower tail quantiles such as ED90 or ED10. Continual reassessment method may be superior if knowledge of the dose–response relationship is available for the drug of interest.

“…Data reported in a previously published clinical study were used (9). Following institutional approval and written informed consent, 52 ASA 1 and 2 children aged 6–15 years presenting for upper or lower gastrointestinal endoscopy were enrolled.…”

Section: Methodsmentioning

confidence: 99%

“…Infusion rates ranged from 1000 to 2300 μg·kg −1 ·min −1 . The rate of infusion for each subject was determined by a randomization schedule (9). Once the loading dose of propofol had been delivered, the infusion rate was maintained at 200 μg·kg −1 ·min −1 for 5 min, or until apnea occurred.…”

Section: Methodsmentioning

confidence: 99%

Two‐stage vs mixed‐effect approach to pharmacodynamic modeling of propofol in children using state entropy

Hahn

Khosravi

Dumont

et al. 2011