MAC reduction of isoflurane by sufentanil

Brunner, M. D.; Braithwaite, P.; Jhaveri, Rajiv; McEwan, Angus; Goodman, David K.; Smith, L. R.; Glass, Peter S. A.

doi:10.1093/bja/72.1.42

Cited by 93 publications

(38 citation statements)

References 29 publications

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“…49 (Glass et al 1999) 1.17 (Glass et al 1999) Ce (50% ➘ MAC) 1.7 (Katoh and Ikeda 1998;Westmoreland et al 1994) 29 (Westmoreland et al 1994) 0.14 (Brunner et al 1994) 1.37 (Lang et al 1996) 1 after injection, and completely recovered within 15 min after injection (Babenco et al 2000). This allowed the estimation of k e0 (0.24 min −1 ) and EC50 (1.12 ng/ml) for respiratory effect.…”

Section: Respiratory Effectsmentioning

confidence: 97%

Remifentanil and Other Opioids

Servin

Billard

Handbook of Experimental Pharmacology

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Most opioids used in anaesthesia are of the anilidopiperidine family, including fentanyl, alfentanil, sufentanil and remifentanil. While all share similar pharmacological properties, remifentanil, the newest one, is probably the most original, which is the reason this review focusses especially on this drug. Remifentanil is a potent mu-agonist that retains all the pharmacodynamic characteristics of its class (regarding analgesia, respiratory depression, muscle rigidity, nausea and vomiting, pruritus, etc.) but with a unique pharmacokinetic profile that combines a short onset and the fastest offset, independent of the infusion duration. Consequently, it offers a unique titratability when its effects need to be quickly achieved or suppressed, but it requires specific drug delivery schemes such as continuous infusion, target-controlled infusion and anticipated postoperative pain treatment. Kinetic differences between opioids used in anaesthesia and some clinical uses of remifentanil are reviewed in this chapter.

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Section: Respiratory Effectsmentioning

confidence: 97%

Remifentanil and Other Opioids

Servin

Billard

Handbook of Experimental Pharmacology

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“…All these problems are exaggerated in elderly patients, and all of them could be substantially mitigated by efective opioid supplementation, but opioids are incompatible with hyperventilation [5,17,18,38,43,44,100,101] . The exaggerated reliance on dangerous muscle relaxants and toxic inhalation agent overpressure engendered by the Waters technique further exaggerates morbidity and mortality [102][103][104][105] .…”

Section: ]Llmentioning

confidence: 99%

“…The limited clinical experience of this author indicates that elective mask induction and intubation followed by maintenance of general endotracheal anesthesia with ½ MAC anesthetic agent complemented by judicious opioid analgesia, minimal paralysis, and permissive hypercarbia combines the advantages of the Waters technique with those of the Crile/ Henderson technique, and eliminates the shortcomings of both [104,105,107,130,139,140] . It ofers a practical, universally applicable means to minimize toxicity and optimize safety, simplicity, eiciency, cost, predictability, patient comfort, and outcome using presently available machines, monitors, and agents.…”

Section: A Practical Technique To Optimize Surgical Stress Controlmentioning

confidence: 99%

Four Forgotten Giants of Anesthesia History

Coleman¹,

Internationals²

2016

JAS

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Introduction Does wisdom perhaps appear on the earth as a raven, which is inspired by the smell of carrion? --Friedrich NietzschePast is prologue. Carbon dioxide confusion has played a pivotal role in the evolution of modern anesthesia. Professional anesthesiology organizations have persistently neglected CO 2 management standards in favor of lesser issues [1][2][3][4] , so that the anesthesiology profession remains mired at the crossroads of revolutionary advance and ongoing self-destruction that can only be understood in historical context. Dr. Ralph Waters founded the profession on the basis of a practical new technique that introduced elective intubation and hyperventilation to abolish CO 2 toxicity disasters, but the harmful habit of hyperventilation has distorted anesthesia beliefs, habits, and practices; derailed research; halted professional advance; discouraged opioid treatment; abolished the therapeutic beneits of CO 2 ; exaggerated morbidity and mortality; and introduced a host of vexing clinical problems. It has indirectly fostered the iction that further improvements in anesthesia safety are impossible, which has undermined reimbursement, emasculated staf privileges, devastated morale, discouraged professional membership A , and rationalized the replacement of anesthesiologists by nurses.Meanwhile, the confusing chemistry, physiology, and pathology of carbon dioxide have yielded their secrets, modern anesthesia machines have eliminated the toxicity problem, modern agents have eliminated explosions, and modern monitoring AbstractThe anesthesiology profession may one day serve as a cautionary tale of how power, politics and privilege can perturb science and progress. Previous anesthesia practitioners possessed a superior understanding of physiology and pharmacology, but overenthusiastic CO 2 supplementation with inadequate monitors and machines caused asphyxiation disasters that were improperly attributed to CO 2 toxicity. Dr. Ralph Waters founded the anesthesiology profession on the basis of a practical new anesthetic technique that introduced elective intubation and hyperventilation to eliminate CO 2 toxicity, but mechanical hyperventilation dangerously depletes CO 2 tissue reserves and exaggerates morbidity and mortality. The beneits of CO 2 supplementation were forgotten, and consequent CO 2 confusion has derailed research, discouraged opioid treatment, damaged patient safety, and disrupted professional progress. Anesthesiologists can no longer claim to provide superior service, and hospital administrators are replacing them with nurses. Professional membership is in decline, and professional survival is in question. Modern machines have eliminated asphyxiation, and modern monitoring enables safe and beneicial hypercarbia that complements opioid treatment and minimizes surgical morbidity and mortality. CO 2 reform promises revolutionary advance but faces formidable opposition. [5] . The restoration of past principles using modern capnography, pulse oximetry, synthetic opioids, and improved inha...

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“…This applies to desirable effects such as enhancement of anesthesia but also to unwanted side effects, in particular, respiratory and-to a much lesser extent-cardiovascular depression. Even maximally effective doses of potent opioids can reduce MAC requirements of volatile anesthetics only by approximately 60% to 70% (78,364,426,752). The MAC lowering effect of a typical postoperative analgesic dose of morphine (0.1 mg/kg) is much smaller and amounts only to about 10% to 20%.…”

Section: Clinical μ-Opioid-receptor Agonistsmentioning

confidence: 99%

Effects of Anesthetics, Sedatives, and Opioids on Ventilatory Control

Stuth

Stucke

Zuperku

2012

Comprehensive Physiology

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This article provides a comprehensive, up to date summary of the effects of volatile, gaseous, and intravenous anesthetics and opioid agonists on ventilatory control. Emphasis is placed on data from human studies. Further mechanistic insights are provided by in vivo and in vitro data from other mammalian species. The focus is on the effects of clinically relevant agonist concentrations and studies using pharmacological, that is, supraclinical agonist concentrations are de-emphasized or excluded.

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MAC reduction of isoflurane by sufentanil

Cited by 93 publications

References 29 publications

Remifentanil and Other Opioids

Remifentanil and Other Opioids

Four Forgotten Giants of Anesthesia History

Effects of Anesthetics, Sedatives, and Opioids on Ventilatory Control

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