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Titolo:
Propofol and remifentanil pharmacodynamic interaction during orthopedic surgical procedures as measured by effects on bispectral index
Autore:
Ropcke, H; Konen-Bermann, M; Cuhls, M; Bouillon, T; Hoeft, A;
Indirizzi:
Univ Bonn, Dept Anesthesia & Intens Care Med, D-53105 Bonn, Germany Univ Bonn Bonn Germany D-53105 & Intens Care Med, D-53105 Bonn, Germany
Titolo Testata:
JOURNAL OF CLINICAL ANESTHESIA
fascicolo: 3, volume: 13, anno: 2001,
pagine: 198 - 207
SICI:
0952-8180(200105)13:3<198:PARPID>2.0.ZU;2-W
Fonte:
ISI
Lingua:
ENG
Soggetto:
LOWER ABDOMINAL-SURGERY; HEMODYNAMIC-RESPONSES; INDUCED SEDATION; SKIN INCISION; ANESTHESIA; ALFENTANIL; CONSCIOUSNESS; FENTANYL; INTENSITY; INFUSION;
Keywords:
bispectral index; drug interaction; electroencephalography; propofol; remifentanil;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
28
Recensione:
Indirizzi per estratti:
Indirizzo: Ropcke, H Univ Bonn, Dept Anesthesia & Intens Care Med, Sigmund Freud Str 25, D-53105 Bonn, Germany Univ Bonn Sigmund Freud Str 25 Bonn Germany D-53105 nn, Germany
Citazione:
H. Ropcke et al., "Propofol and remifentanil pharmacodynamic interaction during orthopedic surgical procedures as measured by effects on bispectral index", J CLIN ANES, 13(3), 2001, pp. 198-207

Abstract

Study Objective: To identify and quantify the interaction between propofoland remifentanil during surgical procedures with a bispectral index (BIS) of 50 that runs chosen as a continuous surrogate measure for "adequate depth" of anesthesia. Design: Prospective, open-label study. Setting: Department of orthopedics of a university hospital. Patients: 20 patients undergoing orthopedic surgery. Interventions: Anesthesia was induced and maintained with propofol and remifentanil, both administered by target-controlled infusion (TCI). Initial target concentrations of propofol (1.5-8 mug/mL) and remifentanil (2-15 ng/mL) were chosen and alternated in order to maintain the BIS between 45 and 55. If constant target concentrations had been maintained for 20 minutes andthe BIS did not depart from the desired range, blood samples were taken todetermine propofol concentrations, and the BIS value runs recorded. Isobolographic interaction models were fitted to the infusion rates of remifentanil and propofol predicted target concentrations of both drugs, and measuredpropofol concentrations venus predicted remifantanil concentrations. Main Results, The isobole for the interaction of propofol and remifentanilin the concentration range investigated (propofol 1.5-8 mug/mL and remifentanil 1-30 ng/mL) is a concave up hyperbola ((0.15 . C-prop)(3.13) . C-rem = 1) with C-prop = propofol plasma concentration [mug/mL] and C-rem = remifentanil blood concentration [ng/mL]). Use of predicted (= TCI target) concentrations or the respective infusion rates did not alter the general shape of the interaction isobole. Conclusions: The interaction between propofol and remifentanil for maintenance of a BIS value between 45 and 55 during surgery is synergistic. This finding applies regardless of whether measured concentrations (for propofol), predicted concentrations of the infusion device, or infusion rates are used as model input. Notably, the interaction isobole of the (clinically readily available) infusion rates provides a useful dosing recommendation for the coadministration of propofol and remifentanil during maintenance of anesthesia. (C) 2001 by Elsevier Science Inc.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/09/20 alle ore 15:25:03