Determination of the 95% effective dose of remifentanil for the prevention of coughing during extubation in children undergoing tonsillectomy (with or without adenoidectomy)

Park, Yong‐Hee; Chung, Eun Jin; Lee, Ji Hyun; Kim, Jin Tae; Kim, Chong Sung; Kim, Hee Soo

doi:10.1111/pan.12616

Cited by 10 publications

(10 citation statements)

References 20 publications

(26 reference statements)

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“…However, following a positive response (success of LOC), the next patient is randomized with a probability of 0.05 to the next lower dose and with a probability of 0.95 to the same dose. Examples of the biased coin up-and-down method in anesthesia studies finding an ED 95 dose can be found in numerous studies [25][26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups

Park

Lee

et al. 2022

Korean J Anesthesiol

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Background: Remimazolam is a new ultrashort-acting benzodiazepine originally developed as an improved version of midazolam. Recent studies demonstrated non-inferiority of remimazolam to propofol in general anesthesia. However, to date, few studies have investigated the induction bolus dose of remimazolam required to achieve general anesthesia. We aimed to determine the 95% effective dose (ED 95 ) of remimazolam bolus that is required to achieve loss of consciousness (LOC) and the appropriate doses for different age groups.Methods: Patients aged 20-79 years with American Society of Anesthesiologists physical status of I or II were enrolled in this study. A total of 120 patients were included representing young, middle-aged, and elderly groups. Loss of eyelash reflex and verbal response after the administration of remimazolam was considered successful LOC. The ED 95 of remimazolam was determined using a biased coin up-and-down design with sequential allocation and the isotonic regression method. Results:The ED 95 of remimazolam for induction of general anesthesia was 0.37 mg/kg (95% confidence interval [CI]: 0.28-0.39) in the young group, 0.37 mg/kg (95% CI: 0.27-0.39) in the middle-aged group, and 0.25 mg/kg (95% CI: 0.2-0.29) in the elderly group. During the study period, none of the patients required rescue medications for hypotension or bradycardia. Conclusions:This study investigated the ED 95 of remimazolam bolus for anesthesia induction, and precise dosing of ED 95 can help maintain hemodynamic stability during induction.

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Section: Discussionmentioning

confidence: 99%

Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups

Park

Lee

et al. 2022

Korean J Anesthesiol

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“…Determination of the sample size for the Dixon's up‐and‐down sequential method has not been clearly defined; however, anaesthesia trials using the up‐and‐down method typically have 20–40 patients 14 . Based on the previous experience with this statistical method, a sample size of 80 paediatric patients was determined to generate a randomization list in a 1:1 ratio 15,16 …”

Section: Methodsmentioning

confidence: 99%

Comparison of the ED50 propofol requirements during the insertion of laryngeal mask airway Ambu AuraFlex with Ambu AuraOnce in children undergoing strabismus surgery

et al. 2021

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What is known and objective Optimal airway management is crucial in strabismus surgery due to the inaccessibility of the airway throughout the procedure. Laryngeal mask airway offers advantages over tracheal intubation in ophthalmic surgery as it does not increase the intraocular pressure. The purpose of this study was to determine the median effective dose of propofol required, when combined with 0.2 µg/kg of sufentanil, for smooth insertion of Ambu AuraFlex in the first attempt in children undergoing strabismus surgery, and to compare it with that for Ambu AuraOnce. Methods Forty‐three paediatric patients undergoing strabismus surgery under general anaesthesia were recruited. For induction, the initial dosage of propofol was 2 mg/kg in the AuraOnce group or 3 mg/kg in the AuraFlex group. In accordance with Dixon's up‐and‐down method, the dose of propofol for consecutive patients in each group was adjusted in increments or decrements of 0.25 mg/kg based on the previous patient's “three‐point, six‐category scale” response to the first attempt of insertion of the randomized device. Insertion of the device was attempted when the bispectral index was ≤60 for 5 s after propofol administration without the use of neuromuscular blocking agents. Results and discussion The median effective dose (95% confidence interval) of propofol was significantly lower in the Ambu AuraOnce group than in the Ambu AuraFlex group (1.92 [1.50–2.32] mg/kg vs. 2.98 [2.49–3.94] mg/kg; p = 0.002). The incidence of dislodgement of the device was significantly higher with the use of the Ambu AuraOnce than with the use of AuraFlex (p = 0.023), whereas insignificant differences were observed between the two groups in the incidence of other perioperative adverse events. What is new and conclusion Ambu AuraFlex requires a significantly higher dose of propofol for insertion and provides more effective and stable airway management in strabismus surgery than AuraOnce.

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“…Examples of BCD in anesthesia studies include identifying the minimum effective dose of lidocaine or ropivacaine needed to effectively block the femoral nerve in 90% of subjects. Pediatric anesthesia examples include determining the speed of a propofol bolus at induction preserving respiration , finding an ED 95 dose of remifentanil allowing extubation without coughing post tonsillectomy , or determining the effect of obesity on ED 95 for propofol during induction .…”

Section: Sequential Design Methodsmentioning

confidence: 99%

Sequential allocation trial design in anesthesia: an introduction to methods, modeling, and clinical applications

Görges

Zhou

Brant

et al. 2017

Pediatric Anesthesia

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Summary Estimation of the dose–response curve for new anesthetic protocols typically focuses on identifying minimum effective doses. The application of a sequential experimental method is appropriate, as it minimizes sample size requirements by updating dose assignments based on information accrued from successive subjects. One approach is the up‐and‐down method for estimating the median effective dose in a patient population (ED50). Designs better suited for achieving greater than 50% effectiveness, include the biased coin approach, and continual reassessment method. In this review we introduce different sequential design methods, provide examples of their use, and show through simulation how the method employed influences sample size and the accuracy of the estimated dose. Simulation studies are presented to illustrate the effects of dose parameter and stopping rule choice for up‐and‐down method and biased coin approach. For continual reassessment method, the effects of assumed dose–response model, prior guess, and cohort size are simulated. A binary response regression curve was fit to the data in Saidman and Eger's endtidal halothane dose‐finding study to provide a dose–response curve for generating simulations. A range of options exist when designing a study using sequential allocation with biased coin approach or continual reassessment method. Method choice influences the required sample size and confidence in estimated effect. In the halothane example, up‐and‐down method decreases the required sample size by 20–30% when the choice of design parameters is optimal. For both up‐and‐down method and biased coin approach designs, greater sample sizes, arising from adjusted stopping criteria, might be required to achieve reliable estimates. The continual reassessment method is only efficient if a limited range of doses can be chosen a priori. In conclusion the up‐and‐down method can be more efficient than nonsequential designs for the estimation of the median dose/intervention level for a given intervention (ED50). The biased coin approach or continual reassessment method are preferred for the estimation of higher or lower tail quantiles such as ED90 or ED10. Continual reassessment method may be superior if knowledge of the dose–response relationship is available for the drug of interest.

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Determination of the 95% effective dose of remifentanil for the prevention of coughing during extubation in children undergoing tonsillectomy (with or without adenoidectomy)

Abstract: The ED95 of the continuous remifentanil infusion rate was 0.060 μg·kg(-1) ·min(-1) to prevent the cough response during extubation in children after tonsillectomy.

Cited by 10 publications

References 20 publications

Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups

Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups

Comparison of the ED50 propofol requirements during the insertion of laryngeal mask airway Ambu AuraFlex with Ambu AuraOnce in children undergoing strabismus surgery

Sequential allocation trial design in anesthesia: an introduction to methods, modeling, and clinical applications

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