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ANESTHETIC PHARMACOLOGY

An Evaluation of Remifentanil Propofol Response Surfaces for Loss of Responsiveness, Loss of Response to Surrogates of Painful Stimuli and Laryngoscopy in Patients Undergoing Elective Surgery

Ken B. Johnson, MD^*, Noah D. Syroid, MS^*, Dhanesh K. Gupta, MD, Sandeep C. Manyam, PhD, Talmage D. Egan, MD^*, Jeremy Huntington, BS^*, Julia L. White, RN^*, Diane Tyler, RN^*, and Dwayne R. Westenskow, PhD^*

From the *Departments of Anesthesiology and Biomedical Engineering, University of Utah, Salt Lake City, Utah; Department of Anesthesiology, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Department of Radiology, University of California, San Francisco, San Francisco, California.

Address correspondence and reprint requests to Ken B. Johnson, MD, Departments of Anesthesiology and Biomedical Engineering, University of Utah, Salt Lake City, UT. Address e-mail to ken.b.johnson{at}hsc.utah.edu.

INTRODUCTION: In this study, we explored how a set of remifentanil-propofol response surface interaction models developed from data collected in volunteers would predict responses to events in patients undergoing elective surgery. Our hypotheses were that these models would predict a patient population’s loss and return of responsiveness and the presence or absence of a response to laryngoscopy and the response to pain after surgery.

METHODS: Twenty-one patients were enrolled. Anesthesia consisted of remifentanil and propofol infusions and fentanyl boluses. Loss and return of responsiveness, responses to laryngoscopy, and responses to postoperative pain were assessed in each patient. Model predictions were compared with observed responses.

RESULTS: The loss of responsiveness model predicted that patients would become unresponsive 2.4 ± 2.6 min earlier than observed. At the time of laryngoscopy, the laryngoscopy model predicted an 89% probability of no response to laryngoscopy and 81% did not respond. During emergence, the loss of responsiveness model predicted return of responsiveness 0.6 ± 5.1 min before responsiveness was observed. The mean probability of no response to pressure algometry was 23% ± 35% when patients required fentanyl for pain control.

DISCUSSION: This preliminary assessment of a series of remifentanil-propofol interaction models demonstrated that these models predicted responses to selected pertinent events during elective surgery. However, significant model error was evident during rapid changes in predicted effect-site propofol-remifentanil concentration pairs.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999