Multicenter Study of Target-Controlled Infusion of Propofol-Sufentanil or Sufentanil-Midazolam for Coronary Artery Bypass Graft Surgery

Jain, Uday; Body, Simon C.; Bellows, Wayne H.; Wolman, Richard L.; Mangano, Christina Mora; Mathew, Joseph P.; Youngs, Elizabeth J.; Wilson, Robert F.; Zhang, Adam; Mangano, Dennis T.

doi:10.1097/00000542-199609000-00011

Cited by 28 publications

(5 citation statements)

References 29 publications

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“…The effect site concentration of sufentanil used in the present study (0.4±0.6 ng mL À1 ) is consistent with what is called`low-dose' sufentanil regimen during cardiac surgery [17]. The average total dose of sufentanil was 2.7 mg kg À1 in the present study which is comparable to that reported by Jain and his colleagues in the`low dose' sufentanil group (2.4 0.8 mg kg À1 ) [17].…”

Section: Clinical Relevance Of the Anaesthetic Regimen Usedsupporting

confidence: 91%

“…The average total dose of sufentanil was 2.7 mg kg À1 in the present study which is comparable to that reported by Jain and his colleagues in the`low dose' sufentanil group (2.4 0.8 mg kg À1 ) [17]. The average total dose of propofol in the present study was 17 mg kg À1 , which is approximately half of that reported by Jain et al (32.6 11.9 mg kg À1 ) [17]. Simulation of predicted propofol concentrations, despite obvious methodological limitations, resulted in predicted average effect site propofol concentrations between 2.7 and 3.4 mg mL À1 (range 2±5 mg mL À1 ).…”

Section: Clinical Relevance Of the Anaesthetic Regimen Usedsupporting

confidence: 89%

“…The average total dose of propofol in the present study was 17 mg kg −1 , which is approximately half of that reported by Jain et al . (32.6 ± 11.9 mg kg −1 ) [17]. Simulation of predicted propofol concentrations, despite obvious methodological limitations, resulted in predicted average effect site propofol concentrations between 2.7 and 3.4 µg mL −1 (range 2–5 µg mL −1 ).…”

Section: Discussionmentioning

confidence: 99%

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Effects of normothermic cardiopulmonary bypass on bispectral index

2000

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This study investigated the changes in the hypnotic component of anaesthesia, estimated by the bispectral index of the electroencephalogram, during normothermic cardiopulmonary bypass. Twenty-six patients (20 men, 6 women), aged 61 +/- 11 years (Mean +/- SD) scheduled for cardiac surgery were premedicated with hydroxyzine and meperidine. Anaesthesia was induced and maintained with a computer-controlled continuous infusion (not adjusted for haemodilution) of sufentanil (effect site concentration 0.4-0.6 ng mL-1) and a manually adjusted continuous infusion of propofol (4.4 +/- 1.8 mg kg-1 h-1). Cardiopulmonary bypass was normothermic with moderate haemodilution. Bispectral index was measured with a referential montage before, 30 s, 1, and 3 min after cardiopulmonary bypass onset, before and after aortic cross-clamping, 30 min after cardiopulmonary bypass onset, before and after aorta cross-clamp release and before and after weaning from cardiopulmonary bypass. Bispectral index values were 48 +/- 8 before cardiopulmonary bypass onset, 50 +/- 10 before, and 48 +/- 8 after end of cardiopulmonary bypass (P = NS). No patient had increases in bispectral index values during cardiopulmonary bypass consistent with awakening. We conclude that with the anaesthetic regimen presented in this study bispectral index values do not change during normothermic cardiopulmonary bypass.

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Section: Clinical Relevance Of the Anaesthetic Regimen Usedsupporting

confidence: 91%

Section: Clinical Relevance Of the Anaesthetic Regimen Usedsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Effects of normothermic cardiopulmonary bypass on bispectral index

2000

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“…Target‐controlled infusions with propofol have been used in human patients for a wide range of procedures, from dental work under sedation (Oei‐Lim and others 1998) to cardiac surgery (Barvais and others 1996, Jain and others 1996). The technique has also been used for conscious sedation during endoscopy (Church and others 1991) and in the intensive care unit (Snellen and others 1990).…”

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confidence: 99%

Evaluation and optimisation of a targetcontrolled infusion system for administering propofol to dogs as part of a total intravenous anaesthetic technique during dental surgery

et al. 2001

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The performance of a modified target-controlled infusion system was investigated in 16 dogs undergoing routine dental work, by comparing the predicted concentrations of propofol in venous blood samples with direct measurements; the optimum targets for the induction and maintenance of anaesthesia were also identified. The performance of a target-controlled infusion system is considered clinically acceptable when the median prediction error, a measure of bias, is not greater than +/-10 to 20 per cent, and the median absolute performance error, a measure of the accuracy, is not greater than 20 to 30 per cent. The results fell within these limits indicating that the system performed adequately. The optimal induction target was 3 microg/ml, and anaesthesia of adequate depth and satisfactory quality was achieved with maintenance targets of between 2.5 and 4.7 microg/ml propofol. The system was easy to use and the quality of anaesthesia was adequate for dental work.

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“…A regimen of TCI sufentanil supplemented with midazolam has been compared with TCI propofol supplemented with sufentanil in patients undergoing cardiac surgery [8]. Outcome in both groups was similar, although there was more hypotension in the propofol-sufentanil group and more hypertension in the sufentanil-midazolam group.…”

Section: Intra-operative Analgesiamentioning

confidence: 99%

Future applications for TCI systems

Milne

1998

Anaesthesia

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SummaryInfusion pumps incorporating 'Diprifusor' for the administration of propofol by target controlled infusion are now commercially available and are becoming more widely used. This paper considers possible future applications of target controlled infusion and summarises results obtained using prototype systems as a component of other control techniques and with other drugs. These include studies with patient-controlled systems for the administration of analgesia or sedation and a closed loop control system for the administration of propofol. Among currently available analgesic drugs, alfentanil and remifentanil are considered to be the most suitable for administration by target controlled infusion, but commercial systems for these agents are not yet available. The technique of target controlled infusion (TCI) has revolutionised the administration of drugs by intravenous infusion. A stable blood concentration is achieved rapidly with TCI, allowing the anaesthetist to monitor therapeutic effect and titrate the drug concentration accordingly. Using 'Diprifusor' (a TCI system for propofol), propofol can be administered by TCI for the induction and maintenance of anaesthesia in adult patients. Recommendation for use in children or for the provision of sedation awaits results from further clinical studies to determine appropriate target concentrations (C T ) for submission for regulatory approval and inclusion in the drug prescribing information. In the meantime, research studies with customised control systems and prototype TCI devices for other drugs provide insight into potential applications for TCI systems which, subject to the availability of commercial equipment, should become more widely used in the future. The ability to maintain a constant blood concentration of drug is also extremely important for studying the pharmacodynamic interactions of drugs and research in this area has increased with the advent of TCI. TCI and analgesiaThe drugs most suitable for administration by TCI are the ones that quickly equilibrate between blood and brain, ensuring a rapid effect when the C T is increased.Morphine has been the gold standard for postoperative analgesia, but its slow blood-brain equilibration and long duration of action prevent rapid alterations in analgesic effect being obtained. Morphine also has active metabolites whose concentrations are not influenced by the use of TCI. The synthetic opioids, such as alfentanil, remifentanil and sufentanil, all have shorter durations of action and are more suitable for use in TCI systems.

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Multicenter Study of Target-Controlled Infusion of Propofol-Sufentanil or Sufentanil-Midazolam for Coronary Artery Bypass Graft Surgery

Cited by 28 publications

References 29 publications

Effects of normothermic cardiopulmonary bypass on bispectral index

Effects of normothermic cardiopulmonary bypass on bispectral index

Evaluation and optimisation of a targetcontrolled infusion system for administering propofol to dogs as part of a total intravenous anaesthetic technique during dental surgery

Future applications for TCI systems

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