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An evaluation of remifentanil-sevoflurane response surface models in patients emerging from anesthesia: model improvement using effect-site sevoflurane concentrations.

dc.contributor.author Egan, TD
dc.contributor.author Gupta, Dhanesh K
dc.contributor.author Johnson, KB
dc.contributor.author LaPierre, CD
dc.contributor.author Manyam, SC
dc.contributor.author Pace, NL
dc.contributor.author Syroid, ND
dc.contributor.author Tyler, Diane
dc.contributor.author Westenskow, DR
dc.contributor.author White, Julia L
dc.coverage.spatial United States
dc.date.accessioned 2015-06-30T18:02:55Z
dc.date.issued 2010-08
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/19820241
dc.identifier ANE.0b013e3181afe31c
dc.identifier.uri http://hdl.handle.net/10161/10242
dc.description.abstract INTRODUCTION: We previously reported models that characterized the synergistic interaction between remifentanil and sevoflurane in blunting responses to verbal and painful stimuli. This preliminary study evaluated the ability of these models to predict a return of responsiveness during emergence from anesthesia and a response to tibial pressure when patients required analgesics in the recovery room. We hypothesized that model predictions would be consistent with observed responses. We also hypothesized that under non-steady-state conditions, accounting for the lag time between sevoflurane effect-site concentration (Ce) and end-tidal (ET) concentration would improve predictions. METHODS: Twenty patients received a sevoflurane, remifentanil, and fentanyl anesthetic. Two model predictions of responsiveness were recorded at emergence: an ET-based and a Ce-based prediction. Similarly, 2 predictions of a response to noxious stimuli were recorded when patients first required analgesics in the recovery room. Model predictions were compared with observations with graphical and temporal analyses. RESULTS: While patients were anesthetized, model predictions indicated a high likelihood that patients would be unresponsive (> or = 99%). However, after termination of the anesthetic, models exhibited a wide range of predictions at emergence (1%-97%). Although wide, the Ce-based predictions of responsiveness were better distributed over a percentage ranking of observations than the ET-based predictions. For the ET-based model, 45% of the patients awoke within 2 min of the 50% model predicted probability of unresponsiveness and 65% awoke within 4 min. For the Ce-based model, 45% of the patients awoke within 1 min of the 50% model predicted probability of unresponsiveness and 85% awoke within 3.2 min. Predictions of a response to a painful stimulus in the recovery room were similar for the Ce- and ET-based models. DISCUSSION: Results confirmed, in part, our study hypothesis; accounting for the lag time between Ce and ET sevoflurane concentrations improved model predictions of responsiveness but had no effect on predicting a response to a noxious stimulus in the recovery room. These models may be useful in predicting events of clinical interest but large-scale evaluations with numerous patients are needed to better characterize model performance.
dc.language eng
dc.relation.ispartof Anesth Analg
dc.relation.isversionof 10.1213/ANE.0b013e3181afe31c
dc.subject Adult
dc.subject Analgesics
dc.subject Anesthesia Recovery Period
dc.subject Anesthetics, Combined
dc.subject Anesthetics, Inhalation
dc.subject Anesthetics, Intravenous
dc.subject Computer Simulation
dc.subject Consciousness
dc.subject Dose-Response Relationship, Drug
dc.subject Drug Synergism
dc.subject Elective Surgical Procedures
dc.subject Female
dc.subject Fentanyl
dc.subject Humans
dc.subject Male
dc.subject Methyl Ethers
dc.subject Middle Aged
dc.subject Models, Biological
dc.subject Pain Measurement
dc.subject Pain Threshold
dc.subject Piperidines
dc.subject Predictive Value of Tests
dc.subject Pulmonary Alveoli
dc.subject Recovery of Function
dc.title An evaluation of remifentanil-sevoflurane response surface models in patients emerging from anesthesia: model improvement using effect-site sevoflurane concentrations.
dc.type Journal article
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/19820241
pubs.begin-page 387
pubs.end-page 394
pubs.issue 2
pubs.organisational-group Anesthesiology
pubs.organisational-group Anesthesiology, Neuroanesthesia
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group School of Medicine
pubs.publication-status Published
pubs.volume 111
dc.identifier.eissn 1526-7598


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