Correlation of exhaled propofol with Narcotrend index and calculated propofol plasma levels in children undergoing surgery under total intravenous anesthesia - an observational study

Abstract Background Exhaled propofol concentrations correlate with propofol concentrations in adult human blood and the brain tissue of rats, as well as with electroencephalography (EEG) based indices of anesthetic depth. The pharmacokinetics of propofol are however different in children compared to adults. The value of exhaled propofol measurements in pediatric anesthesia has not yet been investigated. Breathing system filters and breathing circuits can also interfere with the measurements. In this study, we investigated correlations between exhaled propofol (exP) concentrations and the Narkotrend Index (NI) as well as calculated propofol plasma concentrations. Methods A multi-capillary-column (MCC) combined with ion mobility spectrometry (IMS) was used to determine exP. Optimal positioning of breathing system filters (near-patient or patient-distant) and sample line (proximal or distal to filter) were investigated. Measurements were taken during induction (I), maintenance (M) and emergence (E) of children under total intravenous anesthesia (TIVA). Correlations between ExP concentrations and NI and predicted plasma propofol concentrations (using pediatric pharmacokinetic models Kataria and Paedfusor) were assessed using Pearson correlation and regression analysis. Results Near-patient positioning of breathing system filters led to continuously rising exP values when exP was measured proximal to the filters, and lower concentrations when exP was measured distal to the filters. The breathing system filters were therefore subsequently attached between the breathing system tubes and the inspiratory and expiratory limbs of the anesthetic machine. ExP concentrations significantly correlated with NI and propofol concentrations predicted by pharmacokinetic models during induction and maintenance of anesthesia. During emergence, exP significantly correlated with predicted propofol concentrations, but not with NI. Conclusion In this study, we demonstrated that exP correlates with calculated propofol concentrations and NI during induction and maintenance in pediatric patients. However, the correlations are highly variable and there are substantial obstacles: Without patient proximal placement of filters, the breathing circuit tubing must be changed after each patient, and furthermore, during ventilation, a considerable additional loss of heat and moisture can occur. Adhesion of propofol to plastic parts (endotracheal tube, breathing circle) may especially be problematic during emergence. Trial Registration The study was registered in the German registry of clinical studies (DRKS-ID: DRKS00015795).

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Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data

Journal of Neurosurgery ◽

10.3171/jns.2002.96.3.0571 ◽

2002 ◽

Vol 96 (3) ◽

pp. 571-579 ◽

Cited By ~ 109

Author(s):

Kai-Michael Scheufler ◽

Josef Zentner

Keyword(s):

Motor Evoked Potentials ◽

Plasma Concentrations ◽

Total Intravenous Anesthesia ◽

Neurological Deficits ◽

Experimental Investigations ◽

Intravenous Anesthesia ◽

Content Type ◽

Precise Knowledge ◽

Dose Dependent ◽

Fine Print

Object. Monitoring of descending corticospinal pathways by using motor evoked potentials (MEPs) has proven to be useful in preventing permanent neurological deficits during cranial and spinal procedures. Difficulties in interpretation of intraoperative changes in potentials may largely be attributed to the effects of anesthesia. Development of suitable intravenous anesthesia protocols specifically tailored for MEP monitoring, including plasma level target-controlled infusion (TCI), requires precise knowledge of the specific neurophysiological properties of the various agents. Methods. The effects of alfentanil, sufentanil, fentanyl, remifentanil, thiopental, midazolam, etomidate, ketamine, and propofol on neurogenic and myogenic MEPs were evaluated in an integral study combining clinical data obtained in 40 patients and experimental investigations conducted in 140 animals. The dose-dependent modulation of MEPs after electrical and magnetoelectrical stimulation of the motor cortex was recorded from peripheral muscles and the spinal cord. The results were as follows: opioids, propofol, and thiopental suppressed myogenic, but not neurogenic MEPs in a dose-dependent fashion; remifentanil exerted the least suppressive effects. Etomidate and midazolam did not suppress myogenic MEP, even at plasma concentrations sufficient for anesthesia. Ketamine induced moderate reduction of compound muscle action potential amplitudes only at high doses. Remifentanil and propofol administered via TCI systems allowed recording of myogenic potentials within a defined target plasma concentration range. Conclusions. Development of standardized total intravenous anesthesia/TCI protocols by using anesthetic agents such as propofol, remifentanil, ketamine, and midazolam, which have favorable pharmacokinetic and neurophysiological properties, will enhance the quality of intraoperative MEPs and promote the use of MEP monitoring as a useful tool to reduce surgery-related morbidity.

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Inhalational anesthesia vs total intravenous anesthesia (TIVA) for pediatric anesthesia

Pediatric Anesthesia ◽

10.1111/j.1460-9592.2009.02962.x ◽

2009 ◽

Vol 19 (5) ◽

pp. 521-534 ◽

Cited By ~ 63

Author(s):

JERROLD LERMAN ◽

MARTIN JÖHR

Keyword(s):

Pediatric Anesthesia ◽

Total Intravenous Anesthesia ◽

Inhalational Anesthesia ◽

Intravenous Anesthesia

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Effects on Recovery of Pediatric Patients Undergoing Total Intravenous Anesthesia with Propofol versus Ketofol for Short—Lasting Laparoscopic Procedures

Children ◽

10.3390/children8070610 ◽

2021 ◽

Vol 8 (7) ◽

pp. 610

Author(s):

Ana Nevešćanin Biliškov ◽

Božena Ivančev ◽

Zenon Pogorelić

Keyword(s):

Laparoscopic Surgery ◽

Length Of Stay ◽

Pediatric Patients ◽

Pediatric Anesthesia ◽

Total Intravenous Anesthesia ◽

Time Duration ◽

Intravenous Anesthesia ◽

Group I ◽

Pediatric Populations ◽

Group Ii

Background: Combining ketamine and propofol (ketofol) was suggested as a new concept for sedation and general anesthesia in pediatric populations for various conditions. The aim of the present study was to determine the effect of total intravenous anesthesia (TIVA) with propofol and ketofol on recovery after laparoscopic surgery in pediatric patients. Methods: Two hundred children with median age of 5 years who underwent laparoscopic surgery were randomized into two groups. Propofol 1% was used for induction and maintenance of anesthesia in group I, while ketamine-propofol combination (ketofol) was used in group II. Ketamine-propofol combination (ketofol) was prepared in the same applicator for group II. Ketofol ratios of 1:4 and 1:7 were used for induction and maintenance of anesthesia, respectively. A reduced McFarlan infusion dose was used in group I (1.2, 1.0, and 0.8 mL/kg/h for 15, 15, and 30 min, respectively), while a McFarlan infusion dose was used in group II (1.5, 1.3, and 1.1 mL/kg/h for 15, 15, and 30 min, respectively). Extubating time, duration of anesthesia, and length of stay in post-anesthesia care unit (PACU) were recorded. Results: Extubating time was significantly lower in the ketofol group than in the propofol group (240 s vs. 530 s; p < 0.00001). Significantly shorter duration of anesthesia (47 min vs. 60 min; p < 0.00001) as well as length of stay in the PACU (35 min vs. 100 min; p < 0.00001) were recorded in ketofol compared to the propofol group. Total fentanyl (100 µg (interquartile range, IQR 80, 125) vs. 50 µg (IQR 40, 60); p < 0.00001) and propofol (260 mg (IQR 200, 350) vs. 160 mg (IQR 120, 210); p < 0.00001) consumption per body weight were significantly lower in the ketofol group. Conclusions: TIVA with ketamine-propofol combination (ketofol) using a reduced McFarlan dose regimen shortened extubating time, duration of anesthesia, as well as length of stay in the PACU in pediatric anesthesia after laparoscopic surgery.

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A Comparison of the Sevoflurane and Total Intravenous Anesthesia on the Quality of Recovery in 2 to 10-Year-Old Children

Iranian Journal of Pediatrics ◽

10.5812/ijp.105900 ◽

2020 ◽

Vol In Press (In Press) ◽

Author(s):

Dariush Sheikhzade ◽

Mehdi Razaghipour ◽

Mahin Seyedhejazi ◽

Behzad Aliakbari Sharabiani ◽

Marzieh Marahem

Keyword(s):

General Anesthesia ◽

Outpatient Surgery ◽

Pediatric Anesthesia ◽

Demographic Characteristics ◽

Nausea And Vomiting ◽

Total Intravenous Anesthesia ◽

Intravenous Anesthesia ◽

Sevoflurane Group ◽

Quality Of Recovery

Background: Inhalant anesthesia is one of the mainstays of pediatric anesthesia, and it is considered by the majority of pediatric anesthetists worldwide as the gold standard. On the other hand, total intravenous anesthesia (TIVA) is a very popular choice for routine pediatric anesthesia practice. Therefore, utilization of TIVA compared to the volatile anesthesia is still a topic of debate in successful anesthesia management. Objectives: To compare TIVA vs sevoflurane-based anesthesia on the quality of recovery in children aged 2 to 10 years who had outpatient surgery. Methods: Eighty children, aged 2 to 10 years old undergoing outpatient surgery, were randomly divided into two groups (40 patients each). The TIVA group with propofol (T) received general anesthesia induced with midazolam 0.03 - 0.05 mg/kg, fentanyl 1 mcg/kg, propofol 3 - 5 mg/kg, 0.1 mg/kg lidocaine and maintenance with propofol 100 to 250 μg/kg.min and remifantanil 0.1 mcg/kg. The sevoflurane (S) group received general anesthesia induced with midazolam 0.03 - 0.05 mg/kg, fentanyl 1 mcg/kg, O2/sevoflurane 8 vol%, maintenance with 2 - 3 vol%. Demographic characteristics, awakening quality in recovery, hemodynamic status, and other complications such as patient agitation, pain, nausea, and vomiting were evaluated in both groups. Results: Patients did not differ significantly in terms of demographic characteristics. The incidence of postoperative agitation was 62% higher in the sevoflurane group than the TIVA group (5%, P < 0.001). The highest percentage of pain was obtained as 52.5% in the sevoflurane group. Postoperative nausea and vomiting did not differ significantly among groups, and there was a significant decrease in the heart rate of the subjects in the T group as one of the hemodynamic variables (P = 0.01). Conclusions: Inhalation anesthesia with sevoflurane led to more rapid recovery from anesthesia, and TIVA with propofol injection reduced post-operative pain and agitation compared to patients receiving sevoflurane. Therefore, TIVA with propofol infusion is probably an effective technique to maintain general anesthesia in pediatric outpatient surgery and to increase parental satisfaction, and to reduce the workload of recovery room staff.

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Comparative Effects of Total Intravenous Anesthesia with Propofol and Remifentanil Versus Inhalational Sevoflurane with Dexmedetomidine on Emergence Delirium in Children Undergoing Strabismus Surgery

Anesthesiology and Pain Medicine ◽

10.5812/aapm.109048 ◽

2020 ◽

Vol In Press (In Press) ◽

Author(s):

Mohamed E Oriby ◽

Ayman Elrashidy

Keyword(s):

Recovery Time ◽

Pediatric Anesthesia ◽

Postoperative Nausea And Vomiting ◽

Strabismus Surgery ◽

Total Intravenous Anesthesia ◽

Intravenous Anesthesia ◽

Emergence Delirium ◽

Group I ◽

Group Ii ◽

Postanesthetic Care Unit

Background: Emergence delirium (ED) is common after strabismus surgery due to postoperative visual disturbance, vomiting, and pain. Total intravenous anesthesia (TIVA) has many advantages like smooth emergence from anesthesia, decreased incidence of postoperative nausea and vomiting (PONV), and postoperative analgesia. Objectives: Our study aimed to compare the incidence of ED using inhalational sevoflurane with dexmedetomidine (DEX) versus TIVA with remifentanil. Methods: Eighty-four patients aged 3 - 11 years scheduled for strabismus surgery under general anesthesia were randomly allocated into two groups. Patients in group I received sevoflurane and DEX (group I, n = 42), while group II patients received TIVA with propofol and remifentanil infusion (group II, n = 42). Mean arterial pressure (MAP), heart rate (HR), and pulse oximetry (SpO2) were monitored before induction, at induction, and every 10 minutes during the surgery. In the postanesthetic care unit (PACU), pediatric anesthesia emergence delirium (PAED), face, legs, activity, cry, and consolability (FLACC), need for rescue analgesics, recovery time, level of parents’ satisfaction, and PONV were recorded. Results: Based on the results, HR and MAP significantly decreased 10 and 20 min after induction compared to baseline in group I after infusion of DEX. The incidence of PONV was significantly lower in group II than in group I, while the recovery time was significantly shorter in group I. The incidence of emergence delirium decreased in both groups. Conclusions: The use of either total intravenous anesthesia with propofol and remifentanil or sevoflurane inhalational anesthesia with dexmedetomidine resulted in a lower incidence of emergence delirium, although dexmedetomidine resulted in hypotension, bradycardia, and PONV.

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