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Variability of predicted propofol concentrations and measured sevoflurane concentrations during general anaesthesia: a single-centre retrospective cohort study.
Br J Anaesth
October 2023
Department of Anaesthesia, North Shore Private Hospital, Sydney, NSW, Australia.
Background: Variability is high in predicted propofol concentrations during clinical anaesthesia titrated by target-controlled infusion (TCI) to maintain a processed EEG parameter (bispectral index [BIS]) within a specified range. We have shown that the potential for improving the pharmacokinetic model is minimal. The drug titration paradox revealed that titration challenges the classical relationship between drug dose and effect in both individuals and the population.
View Article and Find Full Text PDFEvaluating efficacy and safety of sub-anesthetic dose esketamine as an adjuvant to propofol/remifentanil analgosedation and spontaneous respiration for children flexible fibreoptic bronchoscopy: a prospective, double-blinded, randomized, and placebo-controlled clinical trial.
Front Pharmacol
May 2023
Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Flexible fiberoptic bronchoscopy (FFB) for children is widely performed under sedation. Currently, the optimal sedation regimen remains unclear. Esketamine is an N-methyl-D-aspartic acid (NMDA) receptor antagonist, which has stronger sedative and analgesic effects and exerts less cardiorespiratory depression than other sedatives.
View Article and Find Full Text PDFAge, minimum alveolar concentration and choice of depth of sedation monitor: examining the paradox of age when using the Narcotrend monitor: A secondary analysis of an observational study.
Eur J Anaesthesiol
April 2022
From the Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern (DH, CS, MH, FS, HAK) and Department of General Internal Medicine, Canton Hospital Frauenfeld, Frauenfeld, Switzerland (CS).
Background: With an ageing global population, it is important to individualise titration of anaesthetics according to age and by measuring their effect on the brain. A recent study reported that during general surgery, the given concentration of volatile anaesthetics, expressed as a fraction of the minimum alveolar concentration (MAC fraction), decreases by around only 3% per age-decade, which is less than the 6% expected from age-adjusted MAC. Paradoxically, despite the excessive dosing, Bispectral index (BIS) values also increased.
View Article and Find Full Text PDFParadox of bispectral index and entropy during burst suppression.
Eur J Anaesthesiol
May 2021
From the GE Healthcare Finland Oy, Helsinki, Finland (MOKS).
The Drug Titration Paradox: Correlation of More Drug With Less Effect in Clinical Data.
Clin Pharmacol Ther
August 2021
Department of Anesthesia, Intensive Care, Emergency and Pain Medicine, Kantonsspital, St Gallen, Switzerland.
While analyzing clinical data where an anesthetic was titrated based on an objective measure of drug effect, we observed paradoxically that greater effect was associated with lesser dose. With this study we sought to find a mathematical explanation for this negative correlation between dose and effect, to confirm its existence with additional clinical data, and to explore it further with Monte Carlo simulations. Automatically recorded dosing and effect data from more than 9,000 patients was available for the analysis.
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