The optimum bolus dose of remifentanil to facilitate laryngeal mask airway insertion with a single standard dose of propofol at induction in children

Kwak, Hyun Jeong; Kim, J Y; Kim, Y B; Chae, Yun Jeong

doi:10.1111/j.1365-2044.2008.05544.x

Cited by 19 publications

(9 citation statements)

References 19 publications

(41 reference statements)

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“…The sample size of this study was based on the fact that a minimum of eight independent pairs of participants showing a crossover point from a ‘movement’ response to a ‘no-movement’ response required for the statistical analysis [ 24 , 25 ]. In similar studies in the field of airway device insertion, the number of crossover points varies from six to eight, with six crossover points being most common [ 23 , 26 , 27 ]. For this study, eight crossovers were considered sufficient to determine the ED 50 of sevoflurane required to insert the suppraglottic airway device Blockbuster™.…”

Section: Methodsmentioning

confidence: 99%

The optimum sevoflurane concentration for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients: a prospective observational study

et al. 2017

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BackgroundAirway management of the obese patient presenting for surgery is more likely to be a challenging problem. Supraglottic airway device has been adopted as a bridge to connect ventilation and tracheal intubation in obese patients who would be suffered with difficult intubation. The optimum sevoflurane concentration for supraglottic airway device insertion allowing spontaneous breathing in 50% of obese patients (ED50) is not known. The purpose of this study was to determine the ED50 of sevoflurane for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients requiring general anesthesia.MethodsThirty elective obese patients (body mass index 30-50 kg/m2) undergoing bariatric surgery were recruited in this study. The predetermined target sevoflurane concentration (initiating at 2.5% with 0.5% as a step size) was sustained for >5 min using a modified Dixon’s up-and-down method, and then the supraglottic airway device Blockbuster™ was inserted. The patient’s response to supraglottic airway device insertion was classified as either ‘movement’ or ‘no-movement’. The ED50 of sevoflurane were determined by calculating the midpoint concentration of crossover point from ‘movement’ or ‘no-movement’ response.ResultsThe ED50 of sevoflurane for supraglottic airway device Blockbuster™ insertion in obese patients calculated using up-and-down method were 2.50 ± 0.60%. The ED50 and ED95 (95% confidence interval) obtained by probit regression analysis were 2.35 (1.28–3.42) % and 4.03 (3.16–17.83) % for supraglottic airway device Blockbuster™ insertion, respectively.ConclusionWe conclude that the optimum end-tidal sevoflurane concentration required for the supraglottic airway device Blockbuster™ insertion allowing spontaneous breathing in 50% of obese patients (ED50) is 2.5 ± 0.6%.Trial registrationChinese Clinical Trial Registry, ChiCTR-IPR-16009071, Registered on 24 August 2016.

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Section: Methodsmentioning

confidence: 99%

The optimum sevoflurane concentration for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients: a prospective observational study

et al. 2017

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“…Below are some suggestions regarding dosing of some of the drugs that may be applicable to the different pain management ladder levels based on the available literature . Table shows dosage suggestions for systemic analgesia, special care must be taken when prescribing opiods in patients with obstructive sleep apnea.…”

Section: Recommendationsmentioning

confidence: 99%

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

Vittinghoff

Lönnqvist

Mossetti

et al. 2018

Pediatric Anesthesia

117

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The main remit of the European Society for Paediatric Anaesthesiology (ESPA) Pain Committee is to improve the quality of pain management in children. The ESPA Pain Management Ladder is a clinical practice advisory based upon expert consensus to help to ensure a basic standard of perioperative pain management for all children. Further steps are suggested to improve pain management once a basic standard has been achieved. The guidance is grouped by the type of surgical procedure and layered to suggest basic, intermediate, and advanced pain management methods. The committee members are aware that there are marked differences in financial and personal resources in different institutions and countries and also considerable variations in the availability of analgesic drugs across Europe. We recommend that the guidance should be used as a framework to guide best practice.

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“…Min, Crawford, and Kwak (51–53) found similar remifentanil dose requirements for oral tracheal intubation (OTI) or laryngeal mask airway (LMA ® ) insertion using sevoflurane/propofol bolus (Table 3), while He et al. (54) showed an inverse relationship between remifentanil and end‐tidal sevoflurane (Etsevo) concentration for OTI in children 3–8 years.…”

Section: General Anesthesiamentioning

confidence: 95%

Remifentanil in children

Sammartino

Garra

Sbaraglia

et al. 2010

Pediatric Anesthesia

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SummaryRemifentanil has gained the confidence of anesthesiologists and has given a real opportunity to change the way anesthesia is given. It can be considered the ideal opioid despite many obstacles to pediatric use: the condition of 'off-label', the lack of wide randomized clinical trials, and the fear of adverse events because of its high potency. Experiences in the field with this opioid over the years encouraged its use. Use has been associated with N 2 0 and volatile agents for general anesthesia and with propofol for total intravenous anesthesia (TIVA). It seems very useful for sedation inside and outside the operating room and in intensive care for both short painful procedures and synchronization with mechanical ventilation. However, its unique pharmacokinetic characteristics causing rapid onset and offset of effect appear unchanged in small children and even in premature neonates and need to be really confirmed by further pharmacokinetic studies. Moreover, the real risks of tolerance and hyperalgesia should be evaluated in the pediatric population. In this review, we go through the newer aspects of this versatile drug that has been proposed as 'the pediatric anesthetist's opiate'.Keywords: remifentanil; pharmacokinetics; pharmacodynamics; shortacting opioids; children; TCI Remifentanil can be considered the best answer to the search for the ideal opioid because of its unique pharmacokinetic characteristics, different from any other opioid (1-4). PharmacokineticsThe ester-linkage makes the compound susceptible to metabolism by nonspecific plasma and tissues esterases, independent from hepatic and renal function (5,6), and it can be safely used even in anhepatic period of liver transplantation or when facing with failure or immaturity of most parenchyma (7,8).Pharmacokinetics (PK) does not change in patients who are deficient in pseudocholinesterase activity, showing that it is not a good substrate for butyrylcholinesterase (9). Remifentanil has a rapid onset, small volume of distribution (Vd), rapid clearance (CL), and a brief half-time (1.0-1.5 min) for equilibration (t ½ Ke0) between plasma and the effect compartment (10). Its extremely short contextsensitive half-life (3-5 min) and the rapid recovery from drug effect are the hallmarks of remifentanil's unicity.

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The optimum bolus dose of remifentanil to facilitate laryngeal mask airway insertion with a single standard dose of propofol at induction in children

Cited by 19 publications

References 19 publications

The optimum sevoflurane concentration for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients: a prospective observational study

The optimum sevoflurane concentration for supraglottic airway device Blockbuster™ insertion with spontaneous breathing in obese patients: a prospective observational study

Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative)

Remifentanil in children

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