Skip to main content
Erschienen in: Journal of Clinical Monitoring and Computing 6/2019

13.03.2019 | Original Research

Acceptance of a propofol and remifentanil infusion dosing algorithm to optimize postoperative emergence and analgesia

verfasst von: Carl Tams, Ken Johnson, Christoph Seubert

Erschienen in: Journal of Clinical Monitoring and Computing | Ausgabe 6/2019

Einloggen, um Zugang zu erhalten

Abstract

We implemented a pharmacokinetic/pharmacodynamic (PK/PD) based optimization algorithm recommending intraoperative Remifentanil and Propofol infusion rates to minimize time to emergence and maximize the duration of analgesia in a clinical setting. This feasibility study tested the clinical acceptance of the optimization algorithm’s recommendations during scoliosis surgical repair for 14 patients. Anesthesiologist accepted 359/394 (91%) of the recommendations given on the basis of the optimization algorithm. While following the optimization’s recommendations the anesthesiologist decreased Propofol infusions from an average of 164–135 mcg/kg/min [p = 0.002] and increased Remifentanil infusions from an average of 0.22–0.30 mcg/kg/min [p = 0.004]. The anesthesiologists appeared to accept and follow the recommendations from a PK/PD based optimization algorithm.
Literatur
1.
Zurück zum Zitat Gornitzky AL, Flynn JM, Muhly WT, Sankar WN. A rapid recovery pathway for adolescent idiopathic scoliosis that improves pain control and reduces time to inpatient recovery after posterior spinal fusion. Spine Deformity. 2016;4:288–95.CrossRef Gornitzky AL, Flynn JM, Muhly WT, Sankar WN. A rapid recovery pathway for adolescent idiopathic scoliosis that improves pain control and reduces time to inpatient recovery after posterior spinal fusion. Spine Deformity. 2016;4:288–95.CrossRef
2.
Zurück zum Zitat Gottschalk A, Durieux M, Nemergut E. Intraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery. Anesth Analg. 2011;112:218–23.CrossRef Gottschalk A, Durieux M, Nemergut E. Intraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery. Anesth Analg. 2011;112:218–23.CrossRef
3.
Zurück zum Zitat Nicholson A. Methadone for cancer pain. Cochrane Database Syst Rev. 2007;17: (4) CD003971. Nicholson A. Methadone for cancer pain. Cochrane Database Syst Rev. 2007;17: (4) CD003971.
4.
Zurück zum Zitat Struys M, Sahinovic M, Lichtenbelt B, Vereeck H, Absalom A. Optimizing intravenous drug administration by applying pharmacokinetic/pharmacodynamic concepts. Br J Anaesth. 2011;107(1):38–47.CrossRef Struys M, Sahinovic M, Lichtenbelt B, Vereeck H, Absalom A. Optimizing intravenous drug administration by applying pharmacokinetic/pharmacodynamic concepts. Br J Anaesth. 2011;107(1):38–47.CrossRef
5.
Zurück zum Zitat Tams C, Syroid N, Johnson K. J Clin Comput Monit. 2019; 8230. Tams C, Syroid N, Johnson K. J Clin Comput Monit. 2019; 8230.
6.
Zurück zum Zitat Pereira J, Lawlor P, Vigano A, Dorgan M, Bruera E. Equianalgesic dose ratios for opioids: a critical review and proposals for long-term dosing. J Pain Symptom Manage. 2001;22(2):672–87.CrossRef Pereira J, Lawlor P, Vigano A, Dorgan M, Bruera E. Equianalgesic dose ratios for opioids: a critical review and proposals for long-term dosing. J Pain Symptom Manage. 2001;22(2):672–87.CrossRef
7.
Zurück zum Zitat Berdine H, Nesbit S. Equianalgesic dosing of opioids. J Pain Palliat Care Pharmacother. 2006; 20(4): 79–84.CrossRef Berdine H, Nesbit S. Equianalgesic dosing of opioids. J Pain Palliat Care Pharmacother. 2006; 20(4): 79–84.CrossRef
8.
Zurück zum Zitat Minto C, Schnider T, Shafer S. Pharmacokinetics and pharmacodynamics of remifentanil II model application. Anesthesiology. 1997;86(1):24–33.CrossRef Minto C, Schnider T, Shafer S. Pharmacokinetics and pharmacodynamics of remifentanil II model application. Anesthesiology. 1997;86(1):24–33.CrossRef
9.
10.
Zurück zum Zitat Tams C, Johnson K. Prediction variability of combined pharmacokinetic pharmacodynamic models: a simulation study of Propofol in combination with remifentanil and fentanyl. J Anesth Clin Res. 2014;5:3.CrossRef Tams C, Johnson K. Prediction variability of combined pharmacokinetic pharmacodynamic models: a simulation study of Propofol in combination with remifentanil and fentanyl. J Anesth Clin Res. 2014;5:3.CrossRef
11.
Zurück zum Zitat Cirillo, et al. Navigator® and SmarPilot ® View are helpful in guiding anesthesia and reducing anesthetic drug dosing. Minerva Anesthiol. 2015;81:1163–9. Cirillo, et al. Navigator® and SmarPilot ® View are helpful in guiding anesthesia and reducing anesthetic drug dosing. Minerva Anesthiol. 2015;81:1163–9.
12.
Zurück zum Zitat Kuizenga M, Hugo V, Struys M. Model-based drug administration: current status of target-controlled infusion and closed-loop control. Curr Opin Anaesthesiol. 2016;29(4):475–81.CrossRef Kuizenga M, Hugo V, Struys M. Model-based drug administration: current status of target-controlled infusion and closed-loop control. Curr Opin Anaesthesiol. 2016;29(4):475–81.CrossRef
13.
Zurück zum Zitat Chidambaran V, Costandi A, D’Mello A. Propofol: a review of its role in pediatric anesthesia and sedation. CNS Drugs. 2015;29(7):543–63.CrossRef Chidambaran V, Costandi A, D’Mello A. Propofol: a review of its role in pediatric anesthesia and sedation. CNS Drugs. 2015;29(7):543–63.CrossRef
Metadaten
Titel
Acceptance of a propofol and remifentanil infusion dosing algorithm to optimize postoperative emergence and analgesia
verfasst von
Carl Tams
Ken Johnson
Christoph Seubert
Publikationsdatum
13.03.2019
Verlag
Springer Netherlands
Erschienen in
Journal of Clinical Monitoring and Computing / Ausgabe 6/2019
Print ISSN: 1387-1307
Elektronische ISSN: 1573-2614
DOI
https://doi.org/10.1007/s10877-019-00295-y

Weitere Artikel der Ausgabe 6/2019

Journal of Clinical Monitoring and Computing 6/2019 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.