Effect site concentration of propofol at induction and recovery of anaesthesia - A correlative dose-response study

Sukumar, Vasanth; Radhakrishnan, Arathi; Keshavan, Venkatesh H

doi:10.4103/ija.ija_670_17

Cited by 9 publications

(7 citation statements)

References 26 publications

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“…Sukumar et al . conducted a study comparing the effect of an IV bolus of propofol at anaesthesia induction and recovery and suggested that propofol aids in smooth anaesthesia induction, maintenance and early recovery 16. Moreover, Mishra et al .…”

Section: Discussionmentioning

confidence: 99%

Comparison of Nitroglycerin versus Lignocaine Spray to Attenuate Haemodynamic Changes in Elective Surgical Patients Undergoing Direct Laryngoscopy and Endotracheal Intubation: A prospective randomised study

Varshney¹,

Prasad²,

Garg³

2019

Sultan Qaboos Univ Med J

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Objectives: This study aimed to compare the effects of nitroglycerin (NTG) versus lignocaine spray in blunting the pressor response during direct laryngoscopy and endotracheal intubation. Methods: This study was conducted between January and June 2018 in the Department of Anesthesiology, Teerthankar Mahaveer Medical College, Moradabad, India. A total of 90 elective surgical patients of American Society of Anesthesiologists physical status grades I or II were divided into three groups, comprising two treatment groups and one control group. Patients in the treatment groups received either one puff (1.5 mg/kg) of lignocaine 10% spray or one puff (400 μg) of NTG spray in the oropharynx one minute prior to the induction of anaesthesia. Haemodynamic variables and mean rate pressure product at baseline and one, two, three, four and five minutes post-induction were compared. Results: There was a significant reduction in mean heart rate at 3–5 minutes in both treatment groups compared to the control group (P <0.050), as well as lower increases in mean arterial pressure at 1–3 minutes (P <0.050). However, at 2–4 minutes, there was a significantly greater decrease in mean systolic blood pressure in the NTG group compared to both the lignocaine and control groups (P <0.050). Moreover, a greater decrease in mean rate pressure product response at 1–5 minutes was observed in the NTG group compared to the lignocaine and control groups (P = 0.001). Conclusion: The NTG spray was more effective than lignocaine in attenuating blood pressure increases and rate pressure product during elective laryngoscopy and intubation.Keywords: Endotracheal Anesthesia; Intubation; Laryngoscopy; Lignocaine; Nitroglycerin; Comparative Effectiveness Research; India.

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Section: Discussionmentioning

confidence: 99%

Comparison of Nitroglycerin versus Lignocaine Spray to Attenuate Haemodynamic Changes in Elective Surgical Patients Undergoing Direct Laryngoscopy and Endotracheal Intubation: A prospective randomised study

Varshney¹,

Prasad²,

Garg³

2019

Sultan Qaboos Univ Med J

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“…Variability in the onset and offset profile of an anesthetic drug is likely due to the factors influencing the pharmacokinetics and the relationship between drug concentrations and their effect [ 16 ]. Ce rather than Cp better reflects the clinical effects of intravenous hypnotics [ 10 , 11 ]; however, administering remimazolam via effect-site target-controlled infusion method is still unavailable. In terms of optimal dosage adjustment, therefore, it would be clinically advantageous if the individual remimazolam Ce could be simulated and applied in clinical practice rather than simply traditional observations of autonomic response along with monitoring of depth of anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…As most drugs act at sites remote from the bloodstream, hysteresis, a phenomenon denoting time lag between the measured plasma drug concentration and the observed drug effect may occur [ 9 ]. Therefore, the pharmacologic effect can be determined based on either the plasma concentration (Cp) or effect-site concentration (Ce); however, Ce rather than the Cp reflects the clinical effects of intravenous anesthetics better [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Effect-site concentration of remimazolam at loss and recovery of responsiveness during general anesthesia: a simulation study

et al. 2022

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Background: The objective of this study was to investigate the effect-site concentration (Ce) of remimazolam at loss of response (LOR) and recovery of response (ROR) in patients underwent general anesthesia using simulation. In addition, the relationships between patient’s factors and simulated Ce at LOR and ROR were examined.Methods: The medical records of 81 patients who underwent elective surgery under general anesthesia using remimazolam with simulation of Ce between August 4, 2021 and October 12, 2021, were retrospectively reviewed. Remimazolam was administered as an induction dose of 6 or 12 mg/kg/h until the patient became unresponsive, followed by 0.32 mg/kg/h to maintain BIS values below 60. Simultaneously, simulations of manual infusion mode were performed using Asan Pump software and the Ce of remimazolam was simulated using the Schüttler model. Whenever infusion rate of remimazolam was manually changed, the simulated Ce was confirmed almost simultaneously. LOR and ROR, defined as unresponsive and eye-opening to verbal commands, respectively, were recorded in the Asan Pump program.Results: The median (1Q, 3Q) simulated Ce at LOR and ROR were 0.7 (0.5, 0.9) and 0.3 (0.2, 0.4) g/ml, respectively. LOR was achieved in 1.9 min after remimazolam infusion with cumulative doses of 0.3 mg/kg. There was a significant relationship between age and simulated Ce at ROR (Ce at ROR = –0.0043 × age + 0.57, r = 0.30, P = 0.014). Conclusions: For optimal dosage adjustment, simulating Ce while administering remimazolam with a weight-based dose during anesthesia is helpful. Elderly patients may recover from anesthesia at lower Ce of remimazolam.

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“…Propofol seems to be an attractive option as it has a favourable pharmacokinetic profile, with a rapid onset of action and early recovery with easy titration of level of sedation. [ 1 ] Single or repeated boluses of propofol for sedation have a rapid onset but lead to unstable plasma levels with the consequent adverse effects like respiratory and haemodynamic instability at peak concentrations and inadequate level of sedation at trough plasma levels. Continuous infusion using manual infusion pump following a bolus injection often leads to increasing blood concentration of propofol over time, requiring repeated adjustments to maintain adequate level of sedation.…”

Section: Introductionmentioning

confidence: 99%

To ascertain the plasma concentration of propofol to achieve bispectral index-guided sedation using a target-controlled infusion in patients undergoing elective surgeries under neuraxial anaesthesia

Sethi¹,

Chhabra²,

Bhatia³

et al. 2022

Indian J Anaesth

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Background and Aims: Sedation improves patient satisfaction, comfort and acceptance of regional anaesthesia. Propofol using bispectral index (BIS)/target-controlled infusion (TCI) system can be an optimal method of sedation, as it combines objective measurement of sedation using BIS along with maintenance of a steady plasma concentration of propofol with the TCI device. The aim of this study was to ascertain the dose and safety of propofol using BIS/TCI system for sedation in patients undergoing surgeries under neuraxial anaesthesia. Methods: One hundred and seven adult patients, undergoing elective surgical procedures under spinal or combined spinal epidural anaesthesia, were recruited. Propofol infusion was started with TCI at an initial target plasma concentration (Cpt) of 1.2 μg/mL, and after equilibration between Cpt and effect site concentration (Ce), propofol was then adjusted in increments and/or decrements of 0.2 μg/mL in order to maintain a BIS value between 60 and 80. The average time to reach BIS = 80 after starting infusion was 7.32 ± 3.13 minutes. The objective was to calculate mean Cpt value maintaining BIS between 60 and 80 and to observe recovery time and complications. Results: Mean Cpt value was 1.13 ± 0.17 mg/mL with 95% confidence interval (1.10–1.16 μg/mL). In 85% of patients, a BIS value of 60–80 was maintained at Cpt ≤ 1.2 μg/mL. No patient had severe complications requiring stoppage of infusion. Conclusion: Propofol sedation using BIS/TCI system can provide safe and convenient sedation during neuraxial anaesthesia at very low plasma concentration, Cpt ≤ 1.2 μg/mL in majority of patients. There were no periprocedural complications, and recovery was rapid.

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Effect site concentration of propofol at induction and recovery of anaesthesia - A correlative dose-response study

Cited by 9 publications

References 26 publications

Comparison of Nitroglycerin versus Lignocaine Spray to Attenuate Haemodynamic Changes in Elective Surgical Patients Undergoing Direct Laryngoscopy and Endotracheal Intubation: A prospective randomised study

Comparison of Nitroglycerin versus Lignocaine Spray to Attenuate Haemodynamic Changes in Elective Surgical Patients Undergoing Direct Laryngoscopy and Endotracheal Intubation: A prospective randomised study

Effect-site concentration of remimazolam at loss and recovery of responsiveness during general anesthesia: a simulation study

To ascertain the plasma concentration of propofol to achieve bispectral index-guided sedation using a target-controlled infusion in patients undergoing elective surgeries under neuraxial anaesthesia

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