Minimum Alveolar Concentration of Isoflurane for Tracheal Extubation in Deeply Anesthetized Children

Neelakanta, Gundappa; Miller, Jordan D.

doi:10.1097/00000542-199404000-00013

Cited by 40 publications

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“…At birth and during the first months of life, MAC is in plateau at its peak value for all drugs, except for halothane, which attains the peak value several months after birth ( (table II). [35,[37][38][39][40][41][42][43][44][45][46][47][48][49][50] In addition, a possible discrepancy between MAC, MACBAR, and the MAC for cardiac depression may explain why halothane has led to a greater number of deaths in neonates compared with older infants. Also, preterm infants are supposed to be more sensitive to cardiac depression than neonates, although very few studies have been carried out in this age group (table II).…”

Section: Inhalation Agentsmentioning

confidence: 99%

“…Neonates 0.87 [37] 1-6mo 1.20 [39] 15 ± 7mo 0.94 [38] Isoflurane Preterm <32wk 1.28 [38] Preterm 32-37wk 1.41 [38] 7-30mo 1.69 [41] Effect of N2O MAC = 1.69 -1.45 × N2O fraction [41] 4-10y 1.69 [42] Effect of temperature 1.47 (34°C), 1.22 (31°C) [6,42] 4-9y 1.27% [43]a Sevoflurane Neonates 3.3 [44] 1-6mo 3.2 [44] 6-12mo 2.5 [44] 1-3y 2.6 [44] 2-12y 2.3-2.5 [44,45] , 2.90, [46] …”

Section: Halothanementioning

confidence: 99%

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Pharmacokinetic/Pharmacodynamic Modeling of Anesthetics in Children

Mazoit

2006

Pediatric Drugs

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Modeling the pharmacokinetics and pharmacodynamics of anesthetics in children is performed as a response to the clinical need for safe and efficacious administration of drugs with a low therapeutic index. Rates and concentrations of these drugs, which are the primary parameters used by anesthesiologists, depend on physiologic parameters that are markedly affected by development. Volatile anesthetics have been used for >50 years in pediatric patients. The pharmacokinetics of inhalation agents are context sensitive, but little difference between age groups has been described. These agents are not only eliminated unchanged by the lung but they are also metabolized by the liver. Halothane has Michaelis-Menten kinetics, with up to 40% of the administered dose metabolized by the liver. For volatile anesthetics, the effect measured is the minimum alveolar concentration (MAC) that leads to movement of the limb in response to skin incision in 50% of the patients studied. The MAC is higher in infants than in children and adults. Infants aged 6 months have a MAC 1.5-1.8 times the MAC observed in adults aged 40 years. Children have a greater clearance and volume of distribution of propofol than adults. In order to achieve similar plasma concentrations, children require three times the initial dose used in adults. In adults, an increased sensitivity to propofol has been demonstrated with aging, but nothing is known about the effects in children. However, it is clear that equipotent doses of propofol induce marked deleterious hemodynamic effects in infants compared with children. Regional anesthesia is used in pediatrics, both in combination with general anesthesia during surgery or alone for postoperative analgesia. A marked decrease in protein binding has been described in infants. In the postoperative period, a rapid increase in binding because of inflammation decreases the free fraction, but the free drug concentration remains constant because of the resulting decrease in total clearance. A low clearance because of liver function immaturity has been observed during the first year(s) of life for bupivacaine and ropivacaine. Pharmacodynamic interactions between general anesthesia and regional anesthesia need to be modeled. This is one of the future tasks for pharmacokineticists. Methods such as the Dixon up-and-down allocation and the isobolographic technique are promising in this field.

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Section: Inhalation Agentsmentioning

confidence: 99%

Section: Halothanementioning

confidence: 99%

Pharmacokinetic/Pharmacodynamic Modeling of Anesthetics in Children

Mazoit

2006

Pediatric Drugs

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“…Such coughing can cause hypertension, tachyarrhythmia and various complications can occur including a subsequent increase in intracranial pressure, bleeding in the operated site, and disruption of surgical wounds from excessive movement [4,5]. Various methods have been studied to prevent coughing during emergence from general anesthesia, such as extubation in a deep plane of anesthesia [6], intra-cuff application of lidocaine [1] or i.v. lidocaine [7], and administration of dexmedetomidine [8] and remifentanil [9,10].…”

Section: Introductionmentioning

confidence: 99%

The effect of a subhypnotic dose of propofol for the prevention of coughing in adults during emergence from anesthesia with sevoflurane and remifentanil

Jung

Park

Kim

2014

Korean J Anesthesiol

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BackgroundCoughing during emergence from general anesthesia may be detrimental. Propofol is known to inhibit airway reflexes. We evaluated the incidence and severity of coughing in adults who received a subhypnotic dose of propofol at the end of sevoflurane-remifentanil anesthesia.MethodsSixty patients, aged 18-65 years, undergoing elective nasal surgery under general anesthesia using sevoflurane and remifentanil were randomly allocated to the propofol group (n = 30) or the control group (n = 30). At the end of surgery, sevoflurane and remifentanil infusion was stopped. After 3 min, the propofol group received propofol 0.3 mg/kg and the control group received normal saline 0.03 ml/kg. The incidence and severity of cough, recovery time and hemodynamic parameters were evaluated during the emergence period.ResultsDuring emergence, the propofol group had the significantly lower incidence (60 vs. 87%) and severity of coughing compared with the control group (P = 0.04, P = 0.02, respectively). There were no significant differences in mean arterial pressure, heart rate, and recovery time during emergence between the two groups.ConclusionsDuring emergence from sevoflurane-remifentanil anesthesia, a subhypnotic dose (0.3 mg/kg) of propofol decreases the incidence and severity of coughing without delaying wake up in adults undergoing nasal surgery.

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“…or topical lidocaine. [5678] However, there are few studies comparing prone and supine extubation on hemodynamic and airway response during emergence from anesthesia.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of hemodynamic changes between prone and supine emergence from anesthesia in lumbar disc surgery

Channabasappa

2013

Anesth Essays Res

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Background:Supine emergence from anesthesia in patients undergoing lumbar surgery in prone position leads to tachycardia, hypertension, coughing, laryngospasm and loss of monitoring as the patients are rolled back to supine position at the end of surgery. The prone extubation might facilitate a smoother emergence because the patients are not disturbed during emergence and secretions are drained away from patient's airway.Materials and Methods:The patients were randomly allocated to one of the two groups of 30 each at conclusion of surgery. First group was extubated in prone position and second in supine position at conclusion of surgery. Supine group patients were rolled back and prone group patients were left undisturbed. Extubation was done after complete reversal of neuromuscular block. Heart rates (HR), mean arterial pressure (MAP) were noted at various points of time. Coughing, laryngospasm, vomiting, monitor disconnection if any were also noted.Results:During emergence from anesthesia heart rate was significantly more in group S than group P at all intervals (P < 0.001). Mean arterial pressure was significantly higher in the supine group at 2, 3, and 4 min compared to prone group (P = 0.003). Compared to supine patients, prone patients had fewer incidences of coughing (P = 0. 0004), laryngospasm, vomiting and monitor disconnection.Conclusion:In healthy normotensive patients, emergence from anesthesia in the prone position is associated with minimal hemodynamic change, and fewer incidences of coughing, laryngospasm, and monitor disconnections.

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Minimum Alveolar Concentration of Isoflurane for Tracheal Extubation in Deeply Anesthetized Children

Cited by 40 publications

References 0 publications

Pharmacokinetic/Pharmacodynamic Modeling of Anesthetics in Children

Pharmacokinetic/Pharmacodynamic Modeling of Anesthetics in Children

The effect of a subhypnotic dose of propofol for the prevention of coughing in adults during emergence from anesthesia with sevoflurane and remifentanil

A comparative study of hemodynamic changes between prone and supine emergence from anesthesia in lumbar disc surgery

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