Weber, Frank and Prasser, Christopher (2019) Investigating propofol-sufentanil interaction using clinical endpoints and processed electroencephalography: a prospective randomized controlled trial. MINERVA ANESTESIOLOGICA, 85 (3). pp. 271-278. ISSN 0375-9393, 1827-1596
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BACKGROUND: Propofol and sufentanil target controlled infusion technology is used with increasing frequency. Drug interaction modelling, using clinical endpoints and processed electroencephalography helps determine optimal drug concentrations to assure adequate anesthesia. METHODS: Sixty patients were randomized to receive a constant concentration of sufentanil (0.25 ng/mL (Group S-0.25), 0.5 ng/mL (Group S-0.5), 0 ng/mL (Group S-0). Propofol was administered in steps of 0.5 mu g/mL, up to 4 mu g/mL. Processed EEG (Bispectral Index, Narcotrend Index) and auditory evoked potentials (composite A-Line autoregressive Index; cAAI), were recorded simultaneously. Sufentanil-propofol interaction was assessed by Probit - and nonlinear regression analysis. RESULTS : Sufentanil had a dose-dependent synergistic effect on the effect-site concentration of propofol (mu g/mL) associated with a 50% probability (EC50) of loss of responsiveness to verbal command (S-0: 2.84 mu g/mL, R-2 0.773; S-0.25: 1.95 mu g/mL, R-2 0.862; S-0.5: 1.48 mu g/mL, R-2 0.887) and noxious stimulation (S-0: 3.46 mu g/mL, R-2 0.626 mu g/mL; S-0.25: 2.17 mu g/mL, R-2 0.853; S-0.5: 1.69 mu g/mL, R-2 0.897). Non-linear regression analysis revealed a synergistic sufentanil effect on the propofol EC50 for BIS (S-0: 3.36 mu g/mL, R-2 0.79; S-0.25: 2.77 mu g/mL, R-2 0.86 mu g/mL; S-0.5: 2.6 mu g/mL, R-2 0.84), Narcotrend Index (S-0: 3.57 mu g/mL, R-2 0.66; S-0.25: 2.91 mu g/mL, R-2 0.70; S-0.5: 2.02 mu g/mL, R-2 0.51) and cAAI (S-0: 3.42 mu g/mL, R-2 0.59; S-0.25: 3.00 mu g/mL, R-2 0.63; S-0.5: 3.14 mu g/mL, R-2 0.59). CONCLUSIONS: Sufentanil has a synergistic effect on the clinically observed hypnotic properties of propofol. These findings apply also to the depth of hypnosis measured by the Bispectral Index, Narcotrend Index and cAAI.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | EFFECT-SITE CONCENTRATION; BISPECTRAL INDEX; COMPOSITE INDEX; ANESTHESIA; PHARMACOKINETICS; ALFENTANIL; SEDATION; PREDICTION; INFUSION; SYNERGY; Propofol; Sufentanil; Drug interactions; Electroencephalography |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 16 Apr 2020 07:53 |
| Last Modified: | 16 Apr 2020 07:53 |
| URI: | https://pred.uni-regensburg.de/id/eprint/27453 |
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