1
|
Sepúlveda PO, Epulef V, Campos G. Why do We Use the Concepts of Adult Anesthesia Pharmacology in Developing Brains? Will It Have an Impact on Outcomes? Challenges in Neuromonitoring and Pharmacology in Pediatric Anesthesia. J Clin Med 2021; 10:2175. [PMID: 34069896 PMCID: PMC8157588 DOI: 10.3390/jcm10102175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pediatric sedation and anesthesia techniques have plenty of difficulties and challenges. Data on the pharmacologic, electroencephalographic, and neurologic response to anesthesia at different brain development times are only partially known. New data in neuroscience, pharmacology, and intraoperative neuromonitoring will impact changing concepts and clinical practice. In this article, we develop a conversation to guide the debate and search for a view more attuned to the updated knowledge in neurodevelopment, electroencephalography, and clinical pharmacology for the anesthesiologic practice in the pediatric population.
Collapse
Affiliation(s)
- Pablo O. Sepúlveda
- Hospital Base San José de Osorno, Service Anesthesiology and Pain, Faculty of Medicine, University Austral, Los Lagos 529000, Chile
| | - Valeria Epulef
- Department of Surgery, Traumatology and Anesthesiology, Medicine Faculty, Universidad de La Frontera, Temuco 4780000, Chile;
- Hospital Hernán Henriquez Aravena, Temuco 4780000, Chile
| | - Gustavo Campos
- Hospital Pediatrico Niño Jesús, Service of Anesthesiology, Córdoba 5500, Argentina;
| |
Collapse
|
2
|
The influence of induction speed on the frontal (processed) EEG. Sci Rep 2020; 10:19444. [PMID: 33173114 PMCID: PMC7655958 DOI: 10.1038/s41598-020-76323-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022] Open
Abstract
The intravenous injection of the anaesthetic propofol is clinical routine to induce loss of responsiveness (LOR). However, there are only a few studies investigating the influence of the injection rate on the frontal electroencephalogram (EEG) during LOR. Therefore, we focused on changes of the frontal EEG especially during this period. We included 18 patients which were randomly assigned to a slow or fast induction group and recorded the frontal EEG. Based on this data, we calculated the power spectral density, the band powers and band ratios. To analyse the behaviour of processed EEG parameters we calculated the beta ratio, the spectral entropy, and the spectral edge frequency. Due to the prolonged induction period in the slow injection group we were able to distinguish loss of responsiveness to verbal command (LOvR) from loss of responsiveness to painful stimulus (LOpR) whereas in the fast induction group we could not. At LOpR, we observed a higher relative alpha and beta power in the slow induction group while the relative power in the delta range was lower than in the fast induction group. When concentrating on the slow induction group the increase in relative alpha power pre-LOpR and even before LOvR indicated that frontal EEG patterns, which have been suggested as an indicator of unconsciousness, can develop before LOR. Further, LOvR was best reflected by an increase of the alpha to delta ratio, and LOpR was indicated by a decrease of the beta to alpha ratio. These findings highlight the different spectral properties of the EEG at various levels of responsiveness and underline the influence of the propofol injection rate on the frontal EEG during induction of general anesthesia.
Collapse
|
3
|
Park J, Choi S, Park J, Lee K, Yun H, Lee E, Choi B, Noh G. Population pharmacokinetic analysis of propofol in underweight patients under general anaesthesia. Br J Anaesth 2018; 121:559-566. [DOI: 10.1016/j.bja.2018.04.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 03/14/2018] [Accepted: 05/20/2018] [Indexed: 11/16/2022] Open
|
4
|
Fuentes R, Cortínez I, Ibacache M, Concha M, Muñoz H. Propofol concentration to induce general anesthesia in children aged 3-11 years with the Kataria effect-site model. Paediatr Anaesth 2015; 25:554-9. [PMID: 25880448 DOI: 10.1111/pan.12657] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The propofol pharmacokinetic model derived by Kataria et al. was recently modified to perform effect-site target-controlled infusion (TCI). Effect-site concentration (Ce) targets to induce general anesthesia with this model in children have not been described. The aim of this study was to identify propofol Ce targets associated with success rates of 50% (Ce50) and 95% (Ce95) among children 3-11 years of age. METHODS Forty-two children were assigned to one of seven groups of six patients each according to propofol target Ce. After fentanyl administration propofol TCI was started with an assigned Ce target. A successful response was defined as loss of eyelash reflex and bispectral index < 50, 45 s after reaching the assigned Ce. Logistic regression analysis was performed to calculate propofol Ce50 and Ce95. RESULTS Twenty-eight children had a successful response with the assigned propofol Ce. In these patients, a significant decrease in mean arterial blood pressure (79-59, P < 0.0001) and in heart rate (95-83, P < 0.0001) was observed. Propofol Ce and age showed a statistically significant effect in the logistic regression model. The overall calculated propofol Ce50 and Ce95 were 3.8 μg·ml(-1) (95% CI: 3.1-4.4 μg·ml(-1) ) and 6.1 μg·ml(-1) (95% CI: 4.6-7.6 μg·ml(-1) ), respectively. CONCLUSION Our results identified useful propofol targets to be used with the Kataria effect-site model to induce anesthesia in children between 3 and 11 years. The recommended targets should be reduced progressively with increasing age most probably due to PK model misspecifications.
Collapse
Affiliation(s)
- Ricardo Fuentes
- Department of Anesthesiology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | | | | | | |
Collapse
|
5
|
Anderson BJ. La farmacología de la anestesia total intravenosa en pediatría. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1016/j.rca.2013.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
6
|
|
7
|
Kuhnle GE, Hornuss C, Lenk M, Salam AP, Wiepcke D, Edelmann-Gahr V, Flake G, Daunderer M, Oberhauser M, Müller HH, Feuerecker M. Impact of propofol on mid-latency auditory-evoked potentials in children. Br J Anaesth 2013; 110:1001-9. [PMID: 23399557 DOI: 10.1093/bja/aet002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Propofol is increasingly used in paediatric anaesthesia, but can be challenging to titrate accurately in this group. Mid-latency auditory-evoked potentials (MLAEPs) can be used to help titrate propofol. However, the effects of propofol on MLAEP in children are unclear. Therefore, we investigated the relationship between propofol and MLAEP in children undergoing anaesthesia. METHODS Fourteen healthy children aged 4-16 yr received anaesthesia for elective surgery. Before surgery, propofol was administered in three concentrations (3, 6, 9 µg ml(-1)) through a target-controlled infusion pump using Kataria and colleagues' model. MLAEPs were recorded 5 min after having reached each target propofol concentration at each respective concentration. Additionally, venous propofol blood concentrations were assayed at each measuring time point. RESULTS Propofol increased all four MLAEP peak latencies (peaks Na, Pa, Nb, P1) in a dose-dependent manner. In addition, the differences in amplitudes were significantly smaller with increasing propofol target concentrations. The measured propofol plasma concentrations correlated positively with the latencies of the peaks Na, Pa, and Nb. CONCLUSIONS Propofol affects MLAEP latencies and amplitudes in children in a dose-dependent manner. MLAEP measurement might therefore be a useful tool for monitoring depth of propofol anaesthesia in children.
Collapse
Affiliation(s)
- G E Kuhnle
- Clinic of Anaesthesiology, SRH Wald-Klinikum Gera GmbH, Straße des Friedens 122, 07548 Gera, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Constant I, Rigouzzo A, Louvet N. Nouvelles avancées en AIVOC pédiatrique au propofol. ACTA ACUST UNITED AC 2013; 32:e37-42. [DOI: 10.1016/j.annfar.2012.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
9
|
Pharmacology of paediatric total intravenous anaesthesia☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2013. [DOI: 10.1097/01819236-201341030-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
10
|
Niu J, Wang SJ, Zhang MZ, Huang YL, Song L, Yu Q, Xu WY. The peak bispectral index time cannot predict early phase propofol pharmacodynamics with effect site-controlled infusion algorithm. Indian J Pharmacol 2012; 44:41-5. [PMID: 22345868 PMCID: PMC3271538 DOI: 10.4103/0253-7613.91865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 07/06/2011] [Accepted: 10/18/2011] [Indexed: 11/23/2022] Open
Abstract
Objectives: The plasma-effect site equilibration rate constant (ke0) of propofol was determined with peak bispectral index (BIS) time (TPEAK) in our previous study. The present study has been conducted to evaluate the ke0's performance with effect site-controlled infusion algorithm. Materials and Methods: Forty unpremedicated patients were randomized to group TE1 (Schnider's pharmacokinetic model with ke0 adapted to TPEAK = 74s) and TE2 (TPEAK = 96s). In stage 1, all patients received propofol with effect-site concentration (Ce) controlled infusion. Once the pump had injected the mass of propofol necessary to achieve pre-set Ce and while the infusion was stopped, target was reset at 0 μg/ml. When BIS returned to 80 or above, then, in stage 2, the patients received plasma concentration controlled infusion for 10 min. The time of loss of responsiveness (LOR) and BIS were recorded. The differences of Ce at the time of LOR, lowest BIS between stages 1 and 2, hysteresis loop were used to evaluate the performance of ke0. Results: In both groups, the calculated propofol Ce at the time of LOR in stages 1 and 2 differed significantly (P<0.01); the mean lowest BIS in stage 1 were significantly higher than those in stage 2 (P < 0.05).The relations of propofol Ce versus BIS revealed the apparent hysteresis loop. Conclusions: The study cannot clinically validate the accuracy of application of ke0 derived from the TPEAK = 74 s of BIS with Schnider propofol pharmacokinetic model.
Collapse
Affiliation(s)
- Jing Niu
- Department of Anesthesiology and Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | | | | | | | | |
Collapse
|
11
|
Hahn JO, Khosravi S, Dosani M, Dumont GA, Mark Ansermino J. Pharmacodynamic modeling of propofol-induced tidal volume depression in children. J Clin Monit Comput 2011; 25:275-84. [DOI: 10.1007/s10877-011-9306-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 09/08/2011] [Indexed: 10/17/2022]
|
12
|
Kim SH, Hong JY, Suk EH, Jeong SM, Park PH. Optimum Bolus dose of Propofol for Tracheal Intubation during Sevoflurane Induction without Neuromuscular Blockade in Children. Anaesth Intensive Care 2011; 39:899-903. [DOI: 10.1177/0310057x1103900540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to determine the optimum bolus dose of propofol required to provide excellent conditions for tracheal intubation following inhalational induction of anaesthesia using 5% sevoflurane without neuromuscular blockade. Twenty-eight children, aged three to seven years, requiring anaesthesia for short duration surgery were recruited. Two minutes after beginning the inhalational induction with 5% sevoflurane and 60% nitrous oxide, a predetermined dose of propofol was injected over 10 seconds. Propofol dose was determined using the Dixon's up-and-down method, starting from 3 mg/kg (0.5 mg/kg as a step size). Laryngoscopy was performed 50 seconds after propofol injection. The optimum dose of propofol required for excellent intubating conditions was 1.39±0.37 mg/kg in 50% of children during inhalation induction using 5% sevoflurane and 60% nitrous oxide in the absence of neuromuscular blocking agents. From probit analysis, the 95% effective dose of propofol was 2.33 mg/kg (95% confidence interval 1.78 to 6.21 mg/kg).
Collapse
Affiliation(s)
- S.-H. Kim
- Department of Anaesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - J.-Y. Hong
- Department of Anaesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - E. H. Suk
- Department of Anaesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - S. M. Jeong
- Department of Anaesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - P. H. Park
- Department of Anaesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
13
|
Kim SH, Hong JY, Suk EH, Jeong SM, Park PH. Optimum Bolus Dose of Propofol for Tracheal Intubation during Sevoflurane Induction without Neuromuscular Blockade in Children. Anaesth Intensive Care 2011. [DOI: 10.1177/0310057x1103900226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to determine the optimum bolus dose of propofol required to provide excellent conditions for tracheal intubation following inhalational induction of anaesthesia using 5% sevoflurane without neuromuscular blockade. Twenty-eight children, aged three to seven years, requiring anaesthesia for short duration surgery were recruited. Two minutes after beginning the inhalational induction with 5% sevoflurane and 60% nitrous oxide, a predetermined dose of propofol was injected over 10 seconds. Propofol dose was determined using the Dixon's up-and-down method, starting from 3 mg/kg (0.5 mg/kg as a step size). Laryngoscopy was performed 50 seconds after propofol injection. The optimum dose of propofol required for excellent intubating conditions was 1.39±0.37 mg/kg in 50% of children during inhalation induction using 5% sevoflurane and 60% nitrous oxide in the absence of neuromuscular blocking agents. From probit analysis, the 95% effective dose of propofol was 2.33 mg/kg (95% confidence interval 1.78 to 6.21 mg/kg).
Collapse
Affiliation(s)
- S.-H. Kim
- Department of Anaesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - J.-Y. Hong
- Department of Anaesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - E. H. Suk
- Department of Anaesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - S. M. Jeong
- Department of Anaesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - P. H. Park
- Department of Anaesthesiology and Pain Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
14
|
Are there still limitations for the use of target-controlled infusion in children? Curr Opin Anaesthesiol 2010; 23:356-62. [DOI: 10.1097/aco.0b013e32833938db] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|