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A previously published propofol–remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery

Modern anesthesia usually employs a hypnotic and an analgesic to produce synergistic sedation and analgesia. Two remifentanil–propofol interaction response surface models were used to predict sedation using Observer's Assessment of Alertness/Sedation (OAA/S) scores; one predicts an OAA/S <2...

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Autores principales: Wang, Hsin-Yi, Ting, Chien-Kun, Liou, Jing-Yang, Chen, Kun-Hui, Tsou, Mei-Young, Chang, Wen-Kuei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5428631/
https://www.ncbi.nlm.nih.gov/pubmed/28489797
http://dx.doi.org/10.1097/MD.0000000000006895
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author Wang, Hsin-Yi
Ting, Chien-Kun
Liou, Jing-Yang
Chen, Kun-Hui
Tsou, Mei-Young
Chang, Wen-Kuei
author_facet Wang, Hsin-Yi
Ting, Chien-Kun
Liou, Jing-Yang
Chen, Kun-Hui
Tsou, Mei-Young
Chang, Wen-Kuei
author_sort Wang, Hsin-Yi
collection PubMed
description Modern anesthesia usually employs a hypnotic and an analgesic to produce synergistic sedation and analgesia. Two remifentanil–propofol interaction response surface models were used to predict sedation using Observer's Assessment of Alertness/Sedation (OAA/S) scores; one predicts an OAA/S <2 and the other <4. We hypothesized that both models would predict regained responsiveness (RR) after video-assisted thoracic surgery (VATS) to reduce total anesthesia time and make early extubation clinically relevant. We included 30 patients undergoing VATS received total intravenous anesthesia (TIVA) combined with thoracic epidural anesthesia (TEA). Pharmacokinetic profiles were calculated using Tivatrainer. Model predictions were compared with observations to evaluate the accuracy and precision of emergence model predictions. The mean (standard deviation) differences between when a patient responded to their name and the time when the model predicted a 50% probability of patient response were 30.80 ± 17.77 and 13.71 ± 11.35 minutes for the OAA/S <2 model and <4 model, respectively. Both models had a limited ability to predict patient response in our patients. Both models identified target concentration pairs predicting time of RR in volunteers and some elective surgeries, but another model of epidural and intravenous anesthetic combinations may be needed to predict time of RR after VATS under TIVA with TEA.
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spelling pubmed-54286312017-05-17 A previously published propofol–remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery Wang, Hsin-Yi Ting, Chien-Kun Liou, Jing-Yang Chen, Kun-Hui Tsou, Mei-Young Chang, Wen-Kuei Medicine (Baltimore) 3300 Modern anesthesia usually employs a hypnotic and an analgesic to produce synergistic sedation and analgesia. Two remifentanil–propofol interaction response surface models were used to predict sedation using Observer's Assessment of Alertness/Sedation (OAA/S) scores; one predicts an OAA/S <2 and the other <4. We hypothesized that both models would predict regained responsiveness (RR) after video-assisted thoracic surgery (VATS) to reduce total anesthesia time and make early extubation clinically relevant. We included 30 patients undergoing VATS received total intravenous anesthesia (TIVA) combined with thoracic epidural anesthesia (TEA). Pharmacokinetic profiles were calculated using Tivatrainer. Model predictions were compared with observations to evaluate the accuracy and precision of emergence model predictions. The mean (standard deviation) differences between when a patient responded to their name and the time when the model predicted a 50% probability of patient response were 30.80 ± 17.77 and 13.71 ± 11.35 minutes for the OAA/S <2 model and <4 model, respectively. Both models had a limited ability to predict patient response in our patients. Both models identified target concentration pairs predicting time of RR in volunteers and some elective surgeries, but another model of epidural and intravenous anesthetic combinations may be needed to predict time of RR after VATS under TIVA with TEA. Wolters Kluwer Health 2017-05-12 /pmc/articles/PMC5428631/ /pubmed/28489797 http://dx.doi.org/10.1097/MD.0000000000006895 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle 3300
Wang, Hsin-Yi
Ting, Chien-Kun
Liou, Jing-Yang
Chen, Kun-Hui
Tsou, Mei-Young
Chang, Wen-Kuei
A previously published propofol–remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery
title A previously published propofol–remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery
title_full A previously published propofol–remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery
title_fullStr A previously published propofol–remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery
title_full_unstemmed A previously published propofol–remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery
title_short A previously published propofol–remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery
title_sort previously published propofol–remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery
topic 3300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5428631/
https://www.ncbi.nlm.nih.gov/pubmed/28489797
http://dx.doi.org/10.1097/MD.0000000000006895
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