Effect-site concentration of remifentanil for smooth emergence from sevoflurane anesthesia in patients undergoing endovascular neurointervention

Kwon, Ji‐Hye; Shin, Young Hee; Gil, Nam-Su; Park, Jungchan; Chung, Yoon Joo; Hahm, Tae Soo; Jeong, Ji Seon

doi:10.1371/journal.pone.0218074

Cited by 4 publications

(5 citation statements)

References 42 publications

(73 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They also found that a remifentanil infusion did not affect the extubation time and the time for awakening, and this was consistent with the results of the present study. Kwon et al (2019) revealed in their study that a remifentanil infusion did not affect the time for awakening. However, it is necessary to pay attention to the adverse reactions of opioids during high-dose infusion ( Zhang et al, 2017 ), as low doses of remifentanil could reduce the incidence of related complications ( Bagshaw et al, 2020 ).…”

Section: Discussionmentioning

confidence: 91%

ED50 value of remifentanil in inhibiting coughing during extubation in children with snoring

et al. 2022

View full text Add to dashboard Cite

Objective: This study aimed to determine the effective dose 50% (ED50) value of remifentanil in inhibiting coughing during extubation in children with snoring.Methods: The subjects were children who scored a grade I in the American Society of Anesthesiology (ASA) metric and who were undergoing tonsillectomy (with or without adenoidectomy) under general anesthesia. Using Dixon’s up-and-down sequential method, the initial infusion rate of remifentanil was 0.06 μg/kg/min, and the difference between the infusion rates of the two adjacent groups was 0.01 μg/kg/min. If a child had no cough response during extubation, the infusion rate for the next child was reduced by 0.01 μg/kg/min. If that child had cough response, the infusion rate for the next child was increased by 0.01 μg/kg/min, and the test was terminated when seven pairs of children with positive-negative alternating results were obtained. The ED50 value and its 95% confidence interval (CI) were calculated by probit regression. The times for extubation, awakening, agitation, and respiratory complications after extubation were compared between the two groups.Results: 1) The ED50 value of a continuous infusion of remifentanil required to inhibit the cough response of children during extubation was 0.042 μg/kg/min, and the 95% confidence interval was 0.025–0.062 μg/kg/min. 2) The total dosage and infusion rate of remifentanil in the cough suppression group were higher than those in the cough group (p < 0.05), but the differences in the times for extubating and awakening between the two groups were not statistically significant (p > 0.05). 3) There was no correlation between the infusion rate of remifentanil and the time for extubating and awakening in the cough suppression group; the r values were 0.13 and 0.12, respectively, and p > 0.05. 4) The differences in postoperative respiratory complications between the two groups were not statistically significant (p > 0.05).Conclusion: The ED50 value of a continuous infusion of remifentanil required to inhibit the cough response of children during extubation after tonsillectomy (with or without adenoidectomy) was 0.042 μg/kg/min, and a low-dose infusion of remifentanil does not affect the times for awakening and extubating in children.

show abstract

Section: Discussionmentioning

confidence: 91%

ED50 value of remifentanil in inhibiting coughing during extubation in children with snoring

et al. 2022

View full text Add to dashboard Cite

show abstract

“…To minimize nociceptive reflexes, we attempted to keep the patients painless. External stimulation was not permitted and remifentanil was maintained at a Ce of 2 ng mL –1 during the study period, which was sufficient to prevent laryngeal irritation 20 , 21 . We also used ANIs as surrogates for pain and maintained ANIs above 50 in both groups at a steady state, which showed a high negative predictive value for postoperative pain 22 – 24 .…”

Section: Discussionmentioning

confidence: 99%

The arousal effect of sugammadex reversal of neuromuscular blockade differs with anesthetic depth in propofol-remifentanil anesthesia: a randomized controlled trial

Kim,

Jang

et al. 2023

Sci Rep

View full text Add to dashboard Cite

Sugammadex reverses neuromuscular blockade by encapsulating steroidal neuromuscular blockers; therefore, it does not pharmacologically affect sedation levels. However, some clinicians avoid using it because of sudden unwanted acting out or patient arousal. Previous studies suggested sugammadex-induced awakening, but frontal muscle contraction after sugammadex administration compromised reliability of results obtained from EEG-based anesthesia depth monitoring tools like bispectral index (BIS). We hypothesized that sugammadex would affect patients’ arousal depending on their baseline levels of sedation. We evaluated arousal signs after sugammadex administration with BIS between 25 − 35 and 45 − 55 under steady-state propofol-remifentanil anesthesia at the end of a surgery (n = 33 in each group). After sugammadex administration, twelve patients with a BIS of 45 − 55 showed clinical signs of awakening but none with a BIS of 25 − 35 (36.4% vs. 0%, P = 0.001). The distribution of the modified observer’s assessment of alertness/sedation scale scores was also significantly different between the two groups (P < 0.001). Changes in the BIS were significantly greater in the BIS 45 − 55 than in the 25 − 35 group (median difference, 7; 95% CI 2 − 19, P = 0.002). Arousal after sugammadex was affected by patient sedation levels, and clinical signs of awakening appeared only in those with BIS 45 − 55. Unwanted arousal of the patient should be considered when using sugammadex under shallow anesthesia.Clinical trial registry number: Clinical Trial Registry of Korea (https://cris.nih.go.kr; Principal investigator: Jieae Kim; Registration number: KCT0006248; Date of first registration: 11/06/2021).

show abstract

“…Another nonmedian up-and-down design, the biasedcoin up-and-down design 7,8,17 is currently popular in anesthesiology, [25][26][27][28][29] possibly owing to its introduction by Pace and Stylianou. Under the biased-coin up-and-down design:…”

Section: Transition Rules Of Common Up-and-down Design Variantsmentioning

confidence: 99%

“…Because this bias increases as the dose gets further from target, it is ill advised to estimate percentiles far from the designated target (e.g., estimating the ED95 using ED50finding up-and-down design data, a practice that has become prevalent in recent anesthesiology studies). 28,[35][36][37][38][39][40] Such estimates are likely biased in the direction of the ED50 (i.e., downward). Furthermore, an ED50-centered up-and-down design would collect few observations near the ends of the dose-response curve, and therefore estimates in that region would rely upon very little direct data.…”

Section: Centered Isotonic Regression and Other Regression Estimatesmentioning

confidence: 99%

See 1 more Smart Citation

Understanding Research Methods: Up-and-down Designs for Dose-finding

2022

View full text Add to dashboard Cite

Summary For the task of estimating a target benchmark dose such as the ED50 (the dose that would be effective for half the population), an adaptive dose-finding design is more effective than the standard approach of treating equal numbers of patients at a set of equally spaced doses. Up-and-down is the most popular family of dose-finding designs and is in common use in anesthesiology. Despite its widespread use, many aspects of up-and-down are not well known, implementation is often misguided, and standard, up-to-date reference material about the design is very limited. This article provides an overview of up-and-down properties, recent methodologic developments, and practical recommendations, illustrated with the help of simulated examples. Additional reference material is offered in the Supplemental Digital Content.

show abstract

Effect-site concentration of remifentanil for smooth emergence from sevoflurane anesthesia in patients undergoing endovascular neurointervention

Cited by 4 publications

References 42 publications

ED50 value of remifentanil in inhibiting coughing during extubation in children with snoring

ED50 value of remifentanil in inhibiting coughing during extubation in children with snoring

The arousal effect of sugammadex reversal of neuromuscular blockade differs with anesthetic depth in propofol-remifentanil anesthesia: a randomized controlled trial

Understanding Research Methods: Up-and-down Designs for Dose-finding

Contact Info

Product

Resources

About