TIVA in children an editorial

Baxter, Alistair; McCormack, Jon

doi:10.1111/pan.13697

Cited by 1 publication

(6 citation statements)

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“…The logistical demand to minimize the number of pumps required for TIVA administration has resulted in a body of work around the use of admixtures (including propofol–remifentanil) for a variety of clinical scenarios 8–10,13,18,19 . One key concern has been the dose accuracy and efficacy of any mixed preparations 1,10 . Early work found prompt aggregation formation after combination of both 1% and 2% propofol emulsions with very high‐concentration remifentanil (50 mcg.ml −1 and 100 mcg.ml ‐1, 20 .…”

Section: Discussionmentioning

confidence: 99%

“…Over the past several decades, TIVA has become an increasingly popular modality in adult and pediatric anesthesia. 1,16,17 The logistical demand to minimize the number of pumps required for TIVA administration has resulted in a body of work around the use of admixtures (including propofol-remifentanil) for a variety of clinical scenarios. [8][9][10]13,18,19 One key concern has been the dose accuracy and efficacy of any mixed preparations.…”

Section: Discussionmentioning

confidence: 99%

“…There has been substantial interest in the use of total intravenous anesthesia (TIVA) in children in the last few years, 1–4 with new and updated models for infusion pumps being released 2 and the pumps themselves becoming more readily available and programmable 3,4 . As use and technique become increasingly sophisticated, multi‐agent infusion regimens—such as propofol and remifentanil—have become more common, 5 with up to 25% of anesthetists in Great Britain regularly using this combination 6,7 …”

Section: Introductionmentioning

confidence: 99%

“…This technique remains unapproved by both the US Food and Drug Administration and the UK Medicines and Healthcare products Regulatory Agency 10 and there are significant concerns about its use. Key pharmacological questions regarding medium and longer‐term stability, 11 miscibility and separation, 12 and subsequently the safety and reliability of the admixture have been raised 1,13 . Encouragingly, recent work has made inroads into addressing safety and dosage concerns in the pediatric clinical context 13 …”

Section: Introductionmentioning

confidence: 99%

“…Key pharmacological questions regarding medium and longer-term stability, 11 miscibility and separation, 12 and subsequently the safety and reliability of the admixture have been raised. 1,13 Encouragingly, recent work has made inroads into addressing safety and dosage concerns in the pediatric clinical context. 13 We hypothesized that despite concerns about miscibility in static conditions, the motion of the pump is adequate to mix or remix the two agents at the "point of administration" (i.e., the tip of the cannula) regardless of the demonstrable agent separation that affects vertically positioned, static, high concentration propofolremifentanil admixtures.…”

Section: Introductionmentioning

confidence: 99%

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Consistency of remifentanil concentrations in propofol–Remifentanil infusions. A laboratory‐based study

Wylie

Beale

Westley

2022

Pediatric Anesthesia

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Background: There is increasing interest in two-agent single-pump intravenous infusions for anesthesia and sedation in pediatric patients. Propofol-remifentanil is one such mixture.The poor miscibility of such admixtures when remifentanil is added in very high concentrations and when the admixtures are maintained in static conditions has been demonstrated; however, these physiochemical properties have not been examined in clinically relevant concentrations or settings. Aim:To examine if propofol-remifentanil admixtures maintain consistent remifentanil delivery when mixed in clinically relevant remifentanil concentrations and subjected to the physical effects of an actively infusing, directly-engaged syringe driver system with an extension line, as occurs when propofol-remifentanil is administered to a patient. Methods:A propofol 10 mg.ml −1 combined with remifentanil 5 mcg.ml −1 solution was run using a Paedfusor ® propofol target-controlled infusion model for 10 kg and 20 kg children for 57 min at a target plasma concentration of 3 mcg.ml −1 through a 30 ml syringe, 180 cm minimum volume extension line, lever lock cannula, interlink injection site, and 22 g intravenous cannula into sample pots. Samples were taken at the completion of the loading bolus, 1 and 2 min postcompletion of loading bolus, and every 5 min thereafter. The remifentanil concentration in these samples was then assayed using chromatography.Results: There was no difference in the concentration of remifentanil in the samples based on the duration of infusion to the endpoint of 1 h, or on the patient weight model used. The concentration remained 5 mcg.ml −1 +/− 0.5 mcg.ml −1 per sample. The measurement uncertainty for the assay at 0.5 mcg.ml −1 is +/− 0.2 mcg.ml −1 . Conclusion:The concentration of remifentanil was 5 mcg.ml −1 +/− 0.5 mcg.ml −1 and was consistent across 57 min of infusion, and two different pediatric weight profiles.

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Section: Discussionmentioning

confidence: 99%