Modeling the Effect of Propofol and Remifentanil Combinations for Sedation-Analgesia in Endoscopic Procedures Using an Adaptive Neuro Fuzzy Inference System (ANFIS)

Gambús, Pedro L.; Jensen, Erik Weber; Jospin, M.; Borrat, X.; Palli, G. Martínez; Fernández-Candil, Juan; Valencia, J.; Barba, X.; Caminal, P.; Trocóniz, Iñaki F.

doi:10.1213/ane.0b013e3182025a70

Cited by 40 publications

(29 citation statements)

References 24 publications

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“…Both the initial target concentrations and the magnitude of the target changes were based on previous work from our group. 1 …”

Section: Drug Administrationmentioning

confidence: 99%

“…The initial target intervals of propofol and remifentanil concentrations to be used in a TCI system for sedation-analgesia in ultrasonographic endoscopic (USE) procedures of the gastrointestinal tract were previously defined. 1 The hierarchical model of the interaction of hypnotic and analgesic effects proposes that opioids could act at different levels in the nervous system attenuating how the noxious stimuli get to the cortex. 2,3 Depending on the intensity reaching cortical levels, an arousal response could be detected on measures of hypnotic effect, as the bispectral index (BIS), observing an increase in BIS value.…”

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confidence: 99%

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Modeling the Influence of the A118G Polymorphism in the OPRM1 Gene and of Noxious Stimulation on the Synergistic Relation between Propofol and Remifentanil

Borrat¹,

Trocóniz

Valencia

et al. 2013

Anesthesiology

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Background:The presence of the A118G single nucleotide polymorphism in the OPRM1 gene as well as noxious stimulation might affect the requirements of remifentanil for patients undergoing ultrasonographic endoscopy under sedation-analgesia with propofol and remifentanil. Bispectral index (BIS) was used as a surrogate measure of effect. Methods:A total of 207 patients were screened for A118G and randomly received different combinations of propofol and remifentanil, changed depending on the nausea response to endoscopy tube introduction. Nonlinear mixed effects modelling was used to establish the relation between propofol and remifentanil with respect to BIS and to investigate the influence of A118G or noxious stimulation. The value of k e0 for propofol and remifentanil was estimated to avoid the hysteresis between predicted effect site concentration (Ce) and BIS. Results: Data from 176 patients were analysed. Eleven were recessive homozygous for A118G (OPRM = 1). A total of 165 patients were either dominant homozygous or heterozygous and considered normal (OPRM = 0). The estimated values of k e0 for propofol and remifentanil were 0.122 and 0.148 min −1 . Propofol and remifentanil were synergistic with respect to the BIS (α = 1.85). EC 50 estimate for propofol was 3.86 µg/ml and for remifentanil 19.6 ng/ml in normal patients and 326 ng/ml in OPRM = 1 patients. BIS increases around 4% for the same effect site concentrations with noxious stimulation. Conclusions: Predicted effect site concentration of remifentanil ranging 1-5 ng/ml synergistically potentiates the effects

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“…Both the initial target concentrations and the magnitude of the target changes were based on previous work from our group. 1 …”

Section: Drug Administrationmentioning

confidence: 99%

mentioning

confidence: 99%

Modeling the Influence of the A118G Polymorphism in the OPRM1 Gene and of Noxious Stimulation on the Synergistic Relation between Propofol and Remifentanil

Borrat¹,

Trocóniz

Valencia

et al. 2013

Anesthesiology

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“…To adjust the algorithm input parameters, an analysis was previously conducted on 106 BIS signals collected from a patients under similar anesthetic procedures to the ones described in section 2.2 [7,6]. From that, the parameters λ and δ were set equal to 20 and 10, respectively.…”

Section: Algorithm Input Parametersmentioning

confidence: 99%

Real-time algorithm for changes detection in depth of anesthesia signals

et al. 2012

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This paper presents a real-time algorithm for changes detection in depth of anesthesia signals. A Page-Hinkley test (PHT) with a forgetting mechanism (PHT-FM) was developed. The samples are weighted according to their "age" so that more importance is given to recent samples. This enables the detection of the changes with less time delay than if no forgetting factor was used. The performance of the PHT-FM was evaluated in a twofold approach. First, the algorithm was run offline in DoA signals previously collected during general anesthesia, allowing the adjustment of the forgetting mechanism. Second, the PHT-FM was embedded in a real-time software and its performance was validated online in the surgery room. This was performed by asking the clinician to classify in real-time the changes as true positives, false positives or false negatives. The results show that 69% of the changes were classified as true positives, 26% as false positives, and 5% as false negatives. The true positives were also synchronized with changes in the hypnotic or analgesic rates made by the clinician. The contribution of this work has a high impact in the clinical practice since the PHT-FM alerts the clinician for changes in the anesthetic state of the patient, allowing a more prompt action. The results encourage the inclusion of the proposed PHT-FM in a real-time decision support system for routine use in the clinical practice.

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“…Previous work from our group showed that the qNOX, a parameter extracted from the raw EEG using an adaptive neuro-fuzzy inference system (ANFIS), could predict the likelihood of movement response to different anesthetic and surgical stimuli [23]. ANFIS is a data driven modelling approach based on the principles of Fuzzy Logic.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery

Melia¹,

Gabarron²,

Agustí

et al. 2016

J Clin Monit Comput

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Purpose. The objective of this work is to compare the behavior of two electroencephalogram (EEG) based indices after drug induction and during recovery of consciousness.Methods. Data was recorded from 140 patients scheduled for general anaesthesia with a combination of propofol and remifentanil. The qCON 2000 monitor (Quantium Medical, Barcelona, Spain) was used to calculate the qCON and qNOX. The fall times and the rise times were defined at the start and at the end of the surgery. Loss of response to verbal command and loss of eye-lash reflex were assessed during the transition from awake to anesthetized, defining the state of loss of consciousness (LOC). Movement as a response to laryngeal mask (LMA) insertion was interpreted as the response to the nociceptive stimuli. The patients were classified as movers or non-movers. The values of qCON and qNOX were statistically compared. Conclusion.The indices qCON and qNOX were able to detect differences between the times of actions of hypnotic and analgesic agents. The qCON showed faster decrease during induction while the qNOX showed a faster increase during recovery.

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Modeling the Effect of Propofol and Remifentanil Combinations for Sedation-Analgesia in Endoscopic Procedures Using an Adaptive Neuro Fuzzy Inference System (ANFIS)

Cited by 40 publications

References 24 publications

Modeling the Influence of the A118G Polymorphism in the OPRM1 Gene and of Noxious Stimulation on the Synergistic Relation between Propofol and Remifentanil

Modeling the Influence of the A118G Polymorphism in the OPRM1 Gene and of Noxious Stimulation on the Synergistic Relation between Propofol and Remifentanil

Real-time algorithm for changes detection in depth of anesthesia signals

Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery

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