The Interaction of Fentanyl on the Cp50 of Propofol for Loss of Consciousness and Skin Incision

Smith, Chris; McEwan, Angus; Jhaveri, Rajiv; Wilkinson, M.; Goodman, D. W.; Smith, L. R.; Canada, Andrew T.; Glass, Peter S. A.

doi:10.1097/00000542-199410000-00008

Cited by 292 publications

(137 citation statements)

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“…A similar concept is applied to intravenous anesthetic agents and is known as the median effective concentration, the EC 50 (Smith et al, 1994). This is a very practical clinical concept because it tends to predict the concentrations of propofol both in the plasma and in the effect site simulated by different pharmacokinetic models (White and Kenny, 1990;Shafer and Gregg, 1992;Smith et al, 1994). Both the MAC for volatile anesthetics and median effect site concentrations for intravenous anesthetics can be expressed by a variety of clinical end-points such as tracheal intubation, extubation, body movement, awareness, recall, or hemodynamic responses.…”

Section: Fig 1 Probability Of Unconsciousness Versus the Bis Values mentioning

confidence: 99%

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Ruan

2014

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To explore the effect of hepatic function on loss of consciousness (LOC) and bispectral index (BIS) during sedation with midazolam (MDZ). Methods: Forty-five patients were assigned to three groups according to their liver function. Thirty of these patients with diagnoses of cholelithiasis were scheduled laparoscopic cholecystectomy, including 15 patients with normal liver function (normal group), and 15 patients with moderately abnormal liver function based on the results of ultrasonic diagnosis of a moderately fatty liver and elevated alanine transaminase levels of less than three times normal (moderate group). The other 15 patients with end-stage liver disease (severe group) underwent liver transplantation. Each patient was administered MDZ by way of target-controlled infusion to increase the concentration gradually. At the time of LOC, the BIS was recorded and a blood sample was withdrawn for measurement of the concentration of MDZ. The concentration of MDZ (EC 50 ) and the BIS value (BIS 50 ) at which 50% of patients lose consciousness were calculated using logistic regression. Results: At the time of LOC, the EC 50 of MDZ and the BIS 50 were similar in the normal and moderate groups (P>0.05). LOC occurred at a lower EC 50 of MDZ and at a higher BIS 50 in the severe group, compared with the normal and moderate groups (P<0.01). Conclusions: Patients with end-stage liver disease were more sensitive to MDZ and this affected the prediction of their time of LOC following MDZ administration. There were no changes in response in patients with moderately abnormal hepatic function.

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Section: Fig 1 Probability Of Unconsciousness Versus the Bis Values mentioning

confidence: 99%

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Ruan

2014

J. Zhejiang Univ. Sci. B

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“…As propofol alone possesses no analgesic activity, additional analgesics are frequently administered during total intravenous anaesthesia (TIVA) with propofol. Fentanyl [1,2] and alfentanil [3] have been reported as reducing the concentration of plasma 50 (Cp50) of propofol required during various noxious stimuli. Nitrous oxide also has an analgesic effect and is often combined with propofol.…”

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confidence: 99%

Cp50 of propofol for laryngeal mask airway insertion using predicted concentrations with and without nitrous oxide

Kodaka

Handa²,

Kawasaki

et al. 2002

Anaesthesia

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SummaryThis study sought to determine the predicted Cp50 of propofol required for laryngeal mask airway insertion (Cp50LMA) and to investigate whether nitrous oxide reduces these required concentrations. Using target-controlled infusion and incorporating the standard Diprifusor TM pharmacokinetic model, 46 unpremedicated patients were randomly assigned to one of two groups. The patients received either 40% oxygen in air (control group: n ¼ 23), or 60% nitrous oxide in oxygen (nitrous oxide group: n ¼ 23). The target concentration for each patient was determined using the up and down method. Following equilibration between the predetermined blood and effect site concentrations, had been established for > 10 min, laryngeal mask airway insertion was attempted without neuromuscular relaxants. The data were analysed using a probit analysis to obtain Cp50LMA levels. The values for Cp50LMA were 3.24 lg.ml )1 in the control group and 1.93 lg.ml )1 in the nitrous oxide group.

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“…The context-sensitive half time is approximately three minutes and as this value does not change as the infusion duration increases the duration of effect of remifentanil is context-insensitive [10]. TCI fentanyl has been used for intraoperative analgesia in combination with isoflurane [11], sevoflurane [12] and propofol [13]. However, when used by infusion prolonged recovery can be a problem.…”

Section: Discussionmentioning

confidence: 99%

“…Three compartment model illustrating the basic pharmacokinetic processes that occur after intravenous drug administration. I, dosing scheme as a function of time; k 10, elimination rate constant reflecting all processes acting to remove drug irreversibly from the central compartment; k eo, elimination rate constant from the effect site; k 12, k 21, k 13 and k 31, inter-compartmental distribution rate constants; V 1, volume (L or L/kg) of central compartment.…”

Section: Introductionmentioning

confidence: 99%

Effect-site Concentration of Alfentanil or Remifentanil for the Relief of Postoperative Pain in the Intensive Care Unit Patients

Jang¹,

Kang²

2015

International Journal of Contents

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The Interaction of Fentanyl on the Cp50 of Propofol for Loss of Consciousness and Skin Incision

Cited by 292 publications

References 0 publications

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Effect of hepatic function on the EC50 of midazolam and the BIS50 at the time of loss of consciousness

Cp50 of propofol for laryngeal mask airway insertion using predicted concentrations with and without nitrous oxide

Effect-site Concentration of Alfentanil or Remifentanil for the Relief of Postoperative Pain in the Intensive Care Unit Patients

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