Predictive Accuracy of Target-controlled Propofol and Sufentanil Coinfusion in Long-lasting Surgery

2000 ◽  
Vol 93 (3) ◽  
pp. 653-661 ◽  
Author(s):  
Pierre C. Pandin ◽  
Francis Cantraine ◽  
Patricia Ewalenko ◽  
Stéphane C. Deneu ◽  
Eddy Coussaert ◽  
...  
Keyword(s):  
Prospective Study ◽  
Pharmacokinetic Model ◽  
Predictive Accuracy ◽  
Hemodynamic Changes ◽  
Target Concentration ◽  
Target Controlled Infusion ◽  
Performance Error ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Infusion Period

Background The predictive accuracy of target concentration infusions of propofol has been documented only for less than 4 h, and no prospective study of sufentanil target controlled infusion is available. The authors investigated the predictive accuracy of pharmacokinetic models for propofol and sufentanil coadministered during long-lasting surgery. Methods Ten patients, American Society of Anesthesiologists physical status I and II, were studied during extended cervicofacial surgery. Target controlled infusion of propofol and sufentanil was administered during surgery using decisional algorithms, taking into consideration pain assessment, hemodynamic changes, and peroperative blood losses. Intrasubject data analysis included calculation of performance error, median performance error, median absolute performance error, divergence, and wobble. Results The range of plasma target concentrations was 2-5 microgram/ml for propofol and 0.2-1 ng/ml for sufentanil. Median performance error was -12.1% for propofol and -10% for sufentanil. The wobble values were 11.6% and 22.3% for propofol and sufentanil, respectively. The pharmacokinetic sets used slightly overpredicted the concentrations, with negative values of divergence of 2.92% and 0.22% units/h for propofol and sufentanil, for a mean infusion period of 762 min. Conclusions This prospective study demonstrates the predictive accuracy of the pharmacokinetic model for sufentanil infusion and confirms that for propofol during long-lasting surgery using standardized rules for the management of target controlled infusion and blood loss replacement.

scholarly journals Perioperative mortality in children in a tertiary teaching hospital in Nigeria: a prospective study

2021 ◽  
Vol 4 (1) ◽  
pp. e000237
Author(s):  
Ademola Olusegun Talabi ◽  
Olugbenga Olalekan Ojo ◽  
Olurotimi Idowu Aaron ◽  
Oludayo Adedapo Sowande ◽  
Folayemi Aramide Faponle ◽  
...  
Keyword(s):  
Prospective Study ◽  
Congenital Anomalies ◽  
Healthcare Delivery ◽  
Mortality Rates ◽  
Perioperative Mortality ◽  
Predictors Of Mortality ◽  
Tertiary Teaching ◽  
American Society ◽  
A Prospective Study ◽  
American Society Of Anesthesiologists

BackgroundPerioperative mortality is one of the tools that can help to assess the adequacy of healthcare delivery in a nation. This audit was conducted to determine the 24-hour, 7-day and 30-day perioperative mortality rates and the predictors of mortality in a pediatric surgical cohort.MethodsThis was a prospective study of children whose ages ranged from a few hours to 15 years and who were operated on between May 2019 and April 2020. The primary outcome was to determine the incidence of in-hospital perioperative mortality.ResultsA total of 530 procedures were done in 502 children. Their ages ranged from a few hours to 15 years with a median of 36 months. The 24-hour, 7-day and 30-day mortality rates were 113.2 per 10 000 procedures [95% confidence interval (CI) =40 to 210], 207.6 per 10 000 procedures (95% CI=110 to 320) and 320.8 per 10 000 procedures (95% CI=190 to 470), respectively. Congenital anomalies complicated by postoperative sepsis contributed to death in the majority of cases. The predictors of mortality were neonatal age group [adjusted odds ratio (AOR)=19.92, 95% CI=2.32 to 170.37, p=0.006], higher American Society of Anesthesiologists Physical Status III and above (AOR=21.6, 95% CI=3.05 to 152.91, p=0.002), emergency surgery (AOR=17.1, 95% CI=5.21 to 60.27, p=0.001), congenital anomalies (AOR=12.7, 95% CI=3.37 to 47.52, p=0.001), and multiple surgical procedures (AOR=9.7, 95% CI=2.79 to 33.54, p=0.001).ConclusionPerioperative mortality remains high in our institution.

Comparison between Different Perforator Imaging Modalities for the Anterolateral Thigh Perforator Flap Transfer: A Prospective Study

2020 ◽  
Vol 36 (09) ◽  
pp. 686-693
Author(s):  
Lucas M. Ritschl ◽  
Andreas M. Fichter ◽  
Achim von Bomhard ◽  
Steffen Koerdt ◽  
Victoria Kehl ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Prospective Study ◽  
Predictive Value ◽  
Perforator Flap ◽  
Flap Transfer ◽  
Anterolateral Thigh ◽  
American Society ◽  
A Prospective Study ◽  
Patient’S History ◽  
American Society Of Anesthesiologists

Abstract Background Perforator imaging is routinely performed before perforator flap harvest. Hand-held Doppler (hhD) and color duplex ultrasonography (CDU) are currently the most popular radiation-free methods for this purpose that can be applied by the surgeon alone. The aim of this study was to compare the accuracy, reliability, and feasibility of hhD and CDU with indocyanine green angiography (ICGA) in the anterolateral thigh perforator flap (ALTPF). Methods All consecutive ALTPF procedures between May 2017 and April 2018 were included in this prospective study. The perforators were visualized by three investigators independently and randomized, applying hhD, CDU, and ICGA. The presence and the distance to the identified perforator were registered. Further, body mass index (BMI), American Society of Anesthesiologists-status, and the patient's history regarding smoking, alcohol use, and diabetes mellitus were registered alongside gender and age to analyze possible confounders. Results A total of 12 patients were enrolled with a median age of 67 (52–87) years. In total, 30 perforators were detected intraoperatively as well as with the ICGA. The latter visualized the perforators significantly more precisely than hhD and CDU (p < 0.001 and p = 0.001). The sensitivity and positive predictive value were 67 and 62% for hhD, 73 and 64% for CDU, and 100 and 100% for ICGA, respectively. Conclusion According to this study, ICGA visualized perforators more accurately than the standard methods hhD and CDU. Further, it was associated with the highest sensitivity and positive predictive value. ICGA consistently delivered excellent results, whereas hhD and CDU showed variability.

scholarly journals Comparison of Pethidine and Tramadol for Control of Shivering in Patients undergoing Elective Surgery under Spinal Anesthesia

2016 ◽  
Vol 4 (2) ◽  
pp. 64
Author(s):  
Mahesh Sharma ◽  
Kalpana Kharbuja ◽  
Bikash Khadka
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Prospective Study ◽  
Postoperative Period ◽  
Elective Surgery ◽  
Sedation Score ◽  
Nausea And Vomiting ◽  
Sympathetic Blockade ◽  
American Society ◽  
American Society Of Anesthesiologists

Introduction: Shivering is a common problem faced by an anesthesiologist during intraoperative as well as in postoperative period, specially after sub-arachnoid block (SAB). It is unpleasant and undesirable and is secondary to vasodilation following sympathetic blockade. The present study was designed to evaluate the efficacy of pethidine on postoperative shivering following SAB and to compare its effects with those of tramadol.   Methods: This randomized, prospective study was conducted in American society of anesthesiologists (ASA) grade I and II  patients undergoing surgery under SAB, to compare the efficacy of tramadol  and pethidine for control of shivering. Patients received tramadol or pethidine in a dose of 0.5mg/kg intra-venously after the appearance of shivering. Disappearance of shivering, side-effects as well as hemodynamics were observed at scheduled intervals.   Results: There were a total of 79 patients randomized into two groups. There were 44 patients receiving pethidine (Group P) and the rest 35 receiving tramadol (Group T). Shivering score was significantly lower in Group P at 10, 15, 20, and 30 minutes compared to that in Group T. Sedation score was higher in pethidine group. Adverse effects in terms of nausea and vomiting was significantly higher in Group T.   Conclusion: Pethidine provide better anti-shivering effect then tramadol with less side effects (nausea and vomiting)  but more sedation.

scholarly journals Comparative study of effective-site target controlled infusion with standard bolus induction of propofol for laryngeal mask airway insertion

2010 ◽  
Vol 4 (1) ◽  
pp. 177-182 ◽  
Author(s):  
Krairerk Sintavanuruk ◽  
Sukanya Pongruekdee ◽  
Russana Thaharavanich ◽  
Surajak Laosuwan ◽  
Somrat Charuluxananan
Keyword(s):  
Success Rate ◽  
Induction Time ◽  
Quality Score ◽  
Laryngeal Mask Airway Insertion ◽  
Target Controlled Infusion ◽  
Group 2 ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Effective Site ◽  
Group 1

Abstract Several studies demonstrated induction of anesthesia with different plasma target-controlled infusion (TCI) of propofol for LMA insertion. However, there has been no study to compare the standard bolus propofol induction with the effective site TCI for LMA insertion. Objective: Compare the efficacy of induction of anesthesia with propofol for LMA insertion between the effective-site TCI, using 6 μg/mL, and the standard bolus propofol dose of 2.5 mg/kg in elective surgical patients. Methods: A randomized, prospective, single-blinded, clinical study was used for this study. Seventy-eight unpremedicated patients, American Society of Anesthesiologists (ASA) physical status I and II undergoing elective surgical procedure were randomly allocated between two groups. Group 1 received the standard bolus propofol dose of 2.5 mg/kg. Group 2 received effective site TCI (Schnider model) dose of 6 μg/mL for LMA insertion. The hemodynamics and anesthetic depth (Bispectral index score) were monitored and recorded during and immediately after LMA insertion. The number of insertion attempted, insertion quality score, induction time, and propofol doses used were recorded and compared between groups. Results: The success rate of first insertion attempt was equal in both groups (92.3%). There was no significant hemodynamic response difference between the groups during pre-induction, induction, insertion, and post insertion period. The BIS score was significantly lower during post insertion period in group 1 (51.4+11.0) than group 2 (58.4+3.2) (p=0.013). The propofol doses in group 2 were significantly lower than in group 1 (110.6+14.8 vs. 153.5+21.5) (p <0.001). Patients in group 2 required significantly more induction time than group 1 (146.9+42.3 vs. 103.4+33.6 (p <0.001). Conclusion: Propofol induction with TCI provided equal success rate as compared with standard bolus propofol induction for LMA insertion and insertion quality score. TCI significantly lowered the propofol consumption when compared with the standard 2.5 mg/kg propofol dose.

Dexmedetomidine Clearance Decreases with Increasing Drug Exposure: Implications for Current Dosing Regimens and Target-controlled Infusion Models Assuming Linear Pharmacokinetics

2021 ◽  
Author(s):  
Ricardo Alvarez-Jimenez ◽  
Maud A. S. Weerink ◽  
Laura N. Hannivoort ◽  
Hong Su ◽  
Michel M. R. F. Struys ◽  
...  
Keyword(s):  
Pharmacokinetic Model ◽  
Drug Exposure ◽  
Plasma Concentrations ◽  
Total Body Weight ◽  
Linear Pharmacokinetics ◽  
Nonlinear Kinetics ◽  
Target Concentration ◽  
Final Model ◽  
Target Controlled Infusion ◽  
Dosing Regimens

Background Numerous pharmacokinetic models have been published aiming at more accurate and safer dosing of dexmedetomidine. The vast majority of the developed models underpredict the measured plasma concentrations with respect to the target concentration, especially at plasma concentrations higher than those used in the original studies. The aim of this article was to develop a dexmedetomidine pharmacokinetic model in healthy adults emphasizing linear versus nonlinear kinetics. Methods The data of two previously published clinical trials with stepwise increasing dexmedetomidine target-controlled infusion were pooled to build a pharmacokinetic model using the NONMEM software package (ICON Development Solutions, USA). Data from 48 healthy subjects, included in a stratified manner, were utilized to build the model. Results A three-compartment mamillary model with nonlinear elimination from the central compartment was superior to a model assuming linear pharmacokinetics. Covariates included in the final model were age, sex, and total body weight. Cardiac output did not explain between-subject or within-subject variability in dexmedetomidine clearance. The results of a simulation study based on the final model showed that at concentrations up to 2 ng · ml–1, the predicted dexmedetomidine plasma concentrations were similar between the currently available Hannivoort model assuming linear pharmacokinetics and the nonlinear model developed in this study. At higher simulated plasma concentrations, exposure increased nonlinearly with target concentration due to the decreasing dexmedetomidine clearance with increasing plasma concentrations. Simulations also show that currently approved dosing regimens in the intensive care unit may potentially lead to higher-than-expected dexmedetomidine plasma concentrations. Conclusions This study developed a nonlinear three-compartment pharmacokinetic model that accurately described dexmedetomidine plasma concentrations. Dexmedetomidine may be safely administered up to target-controlled infusion targets under 2 ng · ml–1 using the Hannivoort model, which assumed linear pharmacokinetics. Consideration should be taken during long-term administration and during an initial loading dose when following the dosing strategies of the current guidelines. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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