Plasma Concentration of Fentanyl with Xenon to Block Somatic and Hemodynamic Responses to Surgical Incision

2000 ◽  
Vol 92 (4) ◽  
pp. 1043-1048 ◽  
Author(s):  
Yoshinori Nakata ◽  
Takahisa Goto ◽  
Hayato Saito ◽  
Yoshiki Ishiguro ◽  
Katsuo Terui ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Plasma Concentrations ◽  
Hemodynamic Response ◽  
Skin Incision ◽  
Computer Assisted ◽  
Hemodynamic Responses ◽  
Surgical Incision ◽  
Model Driven ◽  
Bodily Movement ◽  
Somatic Response

Background Although anesthesia with xenon has been supplemented with fentanyl, its requirement has not been established. This study was conducted to determine the plasma concentrations of fentanyl necessary to suppress somatic and hemodynamic responses to surgical incision in 50% patients in the presence of 0.7 minimum alveolar concentration (MAC) xenon. Methods Twenty-five patients were allocated randomly to predetermined fentanyl concentration between 0.5 and 4.0 ng/ml during 0.7 MAC xenon anesthesia. Fentanyl was administered using a pharmacokinetic model-driven computer-assisted continuous infusion device. At surgical incision each patient was monitored for somatic and hemodynamic responses. A somatic response was defined as any purposeful bodily movement. A positive hemodynamic response was defined as a more than 15% increase in heart rate or mean arterial pressure more than the preincision value. The concentrations of fentanyl to prevent somatic and hemodynamic responses in 50% of patients were calculated using logistic regression. Results The concentration of fentanyl to prevent a somatic response to skin incision in 50% of patients in the presence of 0.7 MAC xenon was 0.72 +/- 0.07 ng/ml and to prevent a hemodynamic response was 0.94 +/- 0.06 ng/ml. Conclusions Comparing these results with previously published results in the presence of 70% nitrous oxide, the fentanyl requirement in xenon anesthesia is smaller than that in the equianesthetic nitrous oxide anesthesia.

The Pharmacodynamic Interaction between Propofol and Fentanyl with Respect to the Suppression of Somatic or Hemodynamic Responses to Skin Incision, Peritoneum Incision, and Abdominal Wall Retraction 

1998 ◽  
Vol 89 (4) ◽  
pp. 894-906 ◽  
Author(s):  
Tomiei Kazama ◽  
Kazuyuki Ikeda ◽  
Koji Morita
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Abdominal Wall ◽  
Skin Incision ◽  
Pressure Increase ◽  
Computer Assisted ◽  
Hemodynamic Responses ◽  
Pharmacodynamic Interaction ◽  
Blood Pressure Increase ◽  
Somatic Response

Background Sufficient propofol or fentanyl doses necessary to prevent the response to skin incision do not necessarily attenuate hemodynamic responses during surgery. The goal of this study was to characterize the pharmacodynamic interaction between propofol and fentanyl with respect to the suppression of somatic or hemodynamic responses after three stimuli: skin incision, peritoneum incision, and abdominal wall retraction. Methods Propofol and fentanyl were administered via computer-assisted continuous infusion to provide equilibration between plasma-blood and biophase concentrations. Patients were randomized to nine groups that received predetermined concentrations of fentanyl (from 0 to 9 ng/ml). Each patient was administered different target concentrations of propofol. Somatic and hemodynamic responses were measured before and after each of three different stimulations: skin incision (si), peritoneum incision (pi), and abdominal wall retraction (ret). The propofol plasma concentrations at which 50% of the patients did not respond to each type of stimulation (Cp50si, Cp50pi, and Cp50ret) were calculated by fitting the Loewe synergistic model. Results For propofol alone, Cp50si, Cp50pi, and Cp50ret were 12.9, 17.1, and 19.4 microg/ml, respectively. Increasing the fentanyl concentration markedly reduced propofol Cp50si, Cp50pi, and Cp50ret for somatic response, indicating the potential synergistic interaction of both drugs. During the prestimulation period, fentanyl did not decrease systolic blood pressure; however, propofol specifically decreased systolic blood pressure. Both drugs had a synergistic drug interaction on the systolic blood pressure increase after various surgical stimulations. Fentanyl and propofol concentrations that suppressed both the 50% probability of somatic response and the 50% probability of moderate hemodynamic change defined by the 15% systolic blood pressure increase over the prestimulation value were 3.6 ng/ml and 2.5 microg/ml for skin incision, 8.4 ng/ml and 1.6 microg/ml for peritoneum incision, and 5.9 ng/ml and 5.1 microg/ml for wall retraction, respectively. Conclusions The anesthesia requirements for stimuli that are more intense than skin incision should be considered during abdominal surgery. Somatic and hemodynamic responses varied depending on the type of surgical stimuli.

Optimal Propofol Plasma Concentration during Upper Gastrointestinal Endoscopy in Young, Middle-aged, and Elderly Patients

2000 ◽  
Vol 93 (3) ◽  
pp. 662-669 ◽  
Author(s):  
Tomiei Kazama ◽  
Ken Takeuchi ◽  
Kazuyuki Ikeda ◽  
Takehiko Ikeda ◽  
Mutsuhito Kikura ◽  
...  
Keyword(s):  
Plasma Concentrations ◽  
Age Groups ◽  
Young Patients ◽  
Upper Gastrointestinal Endoscopy ◽  
Hemodynamic Responses ◽  
Verbal Command ◽  
Group 3 ◽  
Group 2 ◽  
Somatic Response ◽  
Group 1

Background Suitable propofol plasma concentrations during gastroscopy have not been determined for suppressing somatic and hemodynamic responses in different age groups. Methods Propofol sedation at target plasma concentrations from 0.5 to 4.0 microgram/ml were performed randomly in three groups of patients (23 per group) who were undergoing elective outpatient gastroscopy: ages 17-49 yr (group 1), 50-69 yr (group 2), and 70-89 yr (group 3). Plasma propofol concentration in which 50% of patients do not respond to these different stimuli were determined by logistic regression: verbal command (Cp50ls), somatic response to gastroscopy (Cp50endo), and gag response to gastroscopy (Cp50gag). Hemodynamic responses were also investigated in the different age groups. Results Cp50ls concentrations were 2.23 microgram/ml (group 1), 1.75 microgram/ml (group 2), and 1.40 microgram/ml (group 3). The Cp50endo values in groups 1 and 2 were 2.87 and 2.34 microgram/ml, respectively, which were significantly higher than their respective Cp50ls values. Cp50endo value in group 3 was 1.64 microgram/ml, which was close to its Cp50ls value. Because of a high degree of interpatient variability, Cp50gag could not be defined. Systolic blood pressure response decreased with increasing propofol concentrations. Conclusions The authors determined the propofol concentration necessary for gastroscopy and showed that increasing age reduces it. Propofol concentration that suppresses somatic response induces loss of consciousness in almost all young patients.

Esmolol Reduces Anesthetic Requirement for Skin Incision during Propofol/Nitrous Oxide/Morphine Anesthesia

1997 ◽  
Vol 86 (2) ◽  
pp. 364-371 ◽  
Author(s):  
Jay W. Johansen ◽  
Ronald Flaishon ◽  
Peter S. Sebel
Keyword(s):  
Nitrous Oxide ◽  
Continuous Infusion ◽  
Blood Pressure Response ◽  
Beta Blockers ◽  
Venous Blood ◽  
Skin Incision ◽  
Computer Assisted ◽  
High Dose ◽  
Adrenergic Antagonist ◽  
Anesthetic Requirement

Background Although beta blockers have been used primarily to decrease unwanted perioperative hemodynamic responses, the sedative properties of these compounds might decrease anesthetic requirements. This study was designed to determine whether esmolol, a short-acting beta 1-receptor antagonist, could reduce the propofol concentration required to prevent movement at skin incision. Methods Sixty consenting patients were premedicated with morphine, and then propofol was delivered by computer-assisted continuous infusion along with 60% nitrous oxide. Patients were randomly divided into three groups, propofol alone, propofol plus low-dose esmolol (bolus of 0.5 mg/kg, then 50 micrograms.kg-1.min-1), and propofol plus high-dose esmolol (bolus of 1 mg/kg, then 250 micrograms.kg-1.min-1). Two venous blood samples were drawn at equilibrium. The serum propofol concentration that prevented movement to incision in 50% of patients (Cp50) was calculated by logistic regression. Results The propofol Cp50 with nitrous oxide was 3.85 micrograms/ ml. High-dose esmolol infusion was associated with a significant reduction in the Cp50 to 2.80 micrograms/ml (P < 0.04). Propofol computer-assisted continuous infusion produced stable serum concentrations with a slight positive blas. Esmolol did not alter the serum propofol concentration. No intergroup differences in heart rate or blood pressure response to intubation or incision were found. Conclusions Esmolol significantly decreased the anesthetic requirement for skin incision. The components and mechanism of this interaction remain unclear. A simple pharmacokinetic interaction between esmolol and propofol does not explain the Cp50 reduction. These results demonstrate an anesthetic-sparing effect of a beta-adrenergic antagonist in humans under clinically relevant conditions.

Effects of Two Target-controlled Concentrations (1 and 3 ng/ml) of Remifentanil on MACBARof Sevoflurane

2004 ◽  
Vol 100 (2) ◽  
pp. 255-259 ◽  
Author(s):  
Andrea Albertin ◽  
Andrea Casati ◽  
Piercarlo Bergonzi ◽  
Greta Fano ◽  
Giorgio Torri
Keyword(s):  
Nitrous Oxide ◽  
Skin Incision ◽  
Double Blind Study ◽  
Double Blind ◽  
Surgical Incision ◽  
Arterial Blood ◽  
Sequential Allocation ◽  
Sympathetic Responses ◽  
American Society ◽  
End Tidal

Background The aim of this prospective, randomized, double-blind study was to determine the effects of two different target-controlled concentrations of remifentanil (1 and 3 ng/ml) on the sevoflurane requirement for blunting sympathetic responses after surgical incision (MACBAR). Methods Seventy-four patients aged 20-50 yr, with American Society of Anesthesiologists physical status I, were anesthetized with propofol, cisatracurium, and sevoflurane with a mixture of 60% nitrous oxide in oxygen. Then, patients were randomly allocated to receive no remifentanil infusion (n = 27) or a target-controlled plasma concentration of 1 ng/ml (n = 27) or 3 ng/ml remifentanil (n = 20). Sympathetic responses to surgical incision (presence or absence of an increase in either heart rate or mean arterial blood pressure of 15% or more above the mean of the values measured during the 2 min before skin incision) were determined after a 20-min period of stable end-tidal sevoflurane and target-controlled remifentanil concentrations. Predetermined end-tidal sevoflurane concentrations and the MACBAR for each group were determined using an up-and-down sequential-allocation technique. Results The MACBAR of sevoflurane was higher in the group receiving no remifentanil (2.8% [95% confidence interval: 2.5-3.0%]) as compared with patients of the groups receiving 1 ng/ml (1.1% [0.9-1.3%]; P = 0.012) and 3 ng/ml remifentanil (0.2% [0.1-0.3%]; P = 0.006). When considering a minimum anesthetic concentration (MAC) value in this age population and the contribution of 60% nitrous oxide (0.55 MAC), the combined MACBAR values, expressed as multiples of the MAC, were 1.95 MAC, 1.1 MAC, and 0.68 MAC, in the three groups, respectively. Conclusion A target-controlled concentration of 1 ng/ml remifentanil results in a 60% decrease in the MACBAR of sevoflurane combined with 60% nitrous oxide. Increasing the target concentration of remifentanil to 3 ng/ml produces a further 30% decrease in the MACBAR values of sevoflurane.

Effects of Xenon on Hemodynamic Responses to Skin Incision in Humans 

1999 ◽  
Vol 90 (2) ◽  
pp. 406-410 ◽  
Author(s):  
Yoshinori Nakata ◽  
Takahisa Goto ◽  
Shigeho Morita
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Nitrous Oxide ◽  
Systolic Blood Pressure ◽  
Minimum Alveolar Concentration ◽  
Skin Incision ◽  
Hemodynamic Responses ◽  
Probable Explanation ◽  
Hemodynamic Variables ◽  
To Receive

Background The authors evaluated the hemodynamic suppressive effects of xenon in combination with sevoflurane at skin incision in patients undergoing surgery. Methods Forty patients were assigned randomly to receive one of the following four anesthetics: 1.3 minimum alveolar concentration (MAC) sevoflurane, 0.7 MAC xenon with 0.6 MAC sevoflurane, 1 MAC xenon with 0.3 MAC sevoflurane, or 0.7 MAC nitrous oxide with 0.6 MAC sevoflurane (n = 10 each group). Systolic blood pressure and heart rate were measured before anesthesia, before incision, and approximately 1 min after incision. Results The changes in hemodynamic variables in response to incision were less with sevoflurane in combination with xenon and nitrous oxide than with sevoflurane alone. Changes in heart rate (in beats/min) were 19+/-11 (+/- SD) for sevoflurane alone, 11+/-6 for 0.7 MAC xenon-sevoflurane, 4+/-4 for 1 MAC xenon-sevoflurane, and 8+/-7 for nitrous oxide-sevoflurane. Changes in systolic blood pressure were 35+/-18 mmHg for sevoflurane alone, 18+/-8 mmHg for 0.7 MAC xenon-sevoflurane, 16+/-7 mmHg for 1 MAC xenon-sevoflurane, and 14+/-10 mmHg for nitrous oxide-sevoflurane. Conclusions Xenon and nitrous oxide in combination with sevoflurane can reduce hemodynamic responses to skin incision compared with sevoflurane alone. One probable explanation may be that xenon has analgesic properties similar to those of nitrous oxide, although the exact mechanism is yet to be determined.

scholarly journals PLASMA CONCENTRATIONS OF SUFENTANIL REQUIRED TO SUPPRESS HEMODYNAMIC RESPONSES TO NOXIOUS STIMULI DURING NITROUS OXIDE ANESTHESIA

1988 ◽  
Vol 69 (3A) ◽  
pp. A631-A631 ◽  
Author(s):  
J. Marty ◽  
E. Couderc ◽  
F. Servin ◽  
P. Lefevre ◽  
A. Scardin ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Plasma Concentrations ◽  
Hemodynamic Responses ◽  
Noxious Stimuli ◽  
Oxide Anesthesia

Reduction of Isoflurane Minimal Alveolar Concentration by Remifentanil

1996 ◽  
Vol 85 (4) ◽  
pp. 721-728 ◽  
Author(s):  
E. Lang ◽  
A. Kapila ◽  
D. Shlugman ◽  
J. F. Hoke ◽  
P. S. Sebel ◽  
...  
Keyword(s):  
Whole Blood ◽  
Plasma Concentrations ◽  
Skin Incision ◽  
Computer Assisted ◽  
Minimal Alveolar Concentration ◽  
Blood Concentrations ◽  
Isoflurane Concentration ◽  
Arterial Blood ◽  
Opioid Receptor Agonist ◽  
High Concentrations

Background Remifentanil is a new micro-specific opioid receptor agonist currently under investigation. The interaction between opioids and volatile anesthetics is complex. Defining this interaction provides a basis for more rational dosing schemes when such combinations are used for anesthesia and allows the anesthetic potency of remifentanil relative to other opioids to be determined. Methods Two centers enrolled a total of 220 patients. Patients were randomized to receive a target concentration of remifentanil via a computer-assisted continuous infusion device of either 0.0, 0.5, 1.0, 1.5, 2.0, 4.0, 8.0, 16.0, and 32.0 ng/ml initiated before the administration of isoflurane. Patients were also stratified by groups 18-30, 31-55, and 56-65 yr. After induction of anesthesia with isoflurane the initial patient in each dose group was assigned an age-adjusted isoflurane concentration. The isoflurane concentration for each subsequent patient was adjusted according to the up/down technique until a minimum of 12 patients were enrolled in each group. Arterial blood samples for remifentanil whole blood concentrations were obtained. The patient was observed for purposeful movement for up to 1 min after skin incision. The minimum alveolar concentration (MAC) of isoflurane (0 ng/ml remifentanil group) and MAC reduction of isoflurane by remifentanil were determined. Results The MAC of isoflurane alone was 1.3%. Remifentanil caused an exponential reduction in the MAC of isoflurane with 1.37 ng/ml remifentanil a 77% reduction and 32 ng/ml a 91% reduction of isoflurane MAC. Conclusion The MAC reduction of isoflurane by remifentanil is similar to that produced by other opioids. Although remifentanil was given at extremely high concentrations in the absence of isoflurane, it did not provide adequate anesthesia. A 50% isoflurane MAC reduction is produced by 1.37 ng/ml remifentanil whole blood concentration compared to previously published plasma concentrations of fentanyl of 1.67 ng/ml or sufentanil of 0.14 ng/ml.

Bispectral Analysis of the Electroencephalogram Correlates with Patient Movement to Skin Incision during Propofol/Nitrous Oxide Anesthesia

1994 ◽  
Vol 81 (6) ◽  
pp. 1365-1370 ◽  
Author(s):  
Lee A. Kearse ◽  
Paul Manberg ◽  
Nassib Chamoun ◽  
Fred deBros ◽  
Alan Zaslavsky
Keyword(s):  
Nitrous Oxide ◽  
Skin Incision ◽  
Bispectral Analysis ◽  
Patient Movement ◽  
Oxide Anesthesia

scholarly journals Characterization of the hemodynamic response of the hippocampal and parahippocampal regions using FMRI

2021 ◽  
Author(s):  
Priyanka Mehta
Keyword(s):  
Spatial Memory ◽  
Medial Temporal Lobe ◽  
Dominant Role ◽  
Memory Task ◽  
Hemodynamic Response ◽  
Hemodynamic Responses ◽  
Memory Processing ◽  
Time To Peak ◽  
Hemodynamic Characteristics ◽  
The Right

Previous neuroimaging studies have suggested a dominant role of the right medial temporal lobe (MTL) structures- the hippocampal and parahippocampal regions in spatial memory processing. However, the underlying physiological hemodynamic response functions (HRF) of the MTL substructures remain undefined. Given the neuroanatomical differences between these substructures, it is posited that their hemodynamic characteristics are distinct. In this study, the hemodynamic responses of the MTL substructures are investigated using an optimization algorithm that penalizes the curvature (i.e. second derivative) of HRF. The time-to-peak characteristic of the hemodynamic responses revealed that the right CA3 and DG subfields of the hippocampus are significantly more active than the right CA1 subfield during a specific spatial memory task. Further, the hemodynamic responses of the entorhinal, perirhinal and parahippocampal cortices are presented. Together, these findings may help advance our understanding of neurodegenerative diseases like epilepsy and Alzheimer’s disease that are strongly associated to hippocampal dysfunction.

Remifentanil Requirements during Sevoflurane Administration to Block Somatic and Cardiovascular Responses to Skin Incision in Children and Adults

2002 ◽  
Vol 97 (5) ◽  
pp. 1142-1145 ◽  
Author(s):  
Hernán R. Muñoz ◽  
Luis I. Cortínez ◽  
Fernando R. Altermatt ◽  
Jorge A. Dagnino
Keyword(s):  
Infusion Rate ◽  
Cardiovascular Responses ◽  
Skin Incision ◽  
Autonomic Response ◽  
P Value ◽  
Anesthesia Induction ◽  
Remifentanil Infusion ◽  
Autonomic Responses ◽  
Unpaired Student ◽  
Somatic Response

Background The authors found no studies comparing intraoperative requirements of opioids between children and adults, so they determined the infusion rate of remifentanil to block somatic (IR50) and autonomic response (IRBAR50) to skin incision in children and adults. Methods Forty-one adults (aged 20-60 yr) and 24 children (aged 2-10 yr) undergoing lower abdominal surgery were studied. In adults, anesthesia induction was with sevoflurane during remifentanil infusion, whereas in children remifentanil administration was started after induction with sevoflurane. After intubation, sevoflurane was administered in 100% O2 and was adjusted to an ET% of 1 MAC-awake corrected for age at least 15 min before surgery. Patients were randomized to receive remifentanil at a rate ranging from 0.05 to 0.35 microg x kg(-1) x min(-1) for at least 20 min before surgery. At the beginning of surgery, only the skin incision was performed, and the somatic and autonomic responses were observed. The somatic response was defined as positive with any gross movement of extremity, and the autonomic response was deemed positive with any increase in heart rate mean arterial pressure equal to or more than 10% of preincision values. Using logistic regression, the IR50 and IRBAR50 were determined in both groups of patients and compared with unpaired Student t test. A P value less than 0.05 was considered significant. Results The IR50 +/- SD was 0.10 +/- 0.02 microg x kg(-1) x min(-1) in adults and 0.22 +/- 0.03 microg x kg(-1) x min(-1) in children (P < 0.001). The IRBAR50 +/- SD was 0.11 +/- 0.02 microg x kg(-1) x min(-1) in adults and 0.27 +/- 0.06 microg x kg(-1) x min(-1) in children (P < 0.001). Conclusions To block somatic and autonomic responses to surgery, children require a remifentanil infusion rate at least twofold higher than adults.

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