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Interaction between nitrous oxide, sevoflurane, and opioids: a response surface approach

(2013) ANESTHESIOLOGY. 118(4). p.894-902
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Abstract
Background: The interaction of sevoflurane and opioids can be described by response surface modeling using the hierarchical model. We expanded this for combined administration of sevoflurane, opioids, and 66 vol.% nitrous oxide (N2O), using historical data on the motor and hemodynamic responsiveness to incision, the minimal alveolar concentration, and minimal alveolar concentration to block autonomic reflexes to nociceptive stimuli, respectively. Methods: Four potential actions of 66 vol.% N2O were postulated: (1) N2O is equivalent to A ng/ml of fentanyl (additive); (2) N2O reduces C50 of fentanyl by factor B; (3) N2O is equivalent to X vol.% of sevoflurane (additive); (4) N2O reduces C50 of sevoflurane by factor Y. These four actions, and all combinations, were fitted on the data using NON-MEM (version VI, Icon Development Solutions, Ellicott City, MD), assuming identical interaction parameters (A, B, X, Y) for movement and sympathetic responses. Results: Sixty-six volume percentage nitrous oxide evokes an additive effect corresponding to 0.27 ng/ml fentanyl (A) with an additive effect corresponding to 0.54 vol.% sevoflurane (X). Parameters B and Y did not improve the fit. Conclusion: The effect of nitrous oxide can be incorporated into the hierarchical interaction model with a simple extension. The model can be used to predict the probability of movement and sympathetic responses during sevoflurane anesthesia taking into account interactions with opioids and 66 vol.% N2O.
Keywords
FENTANYL, MAC, REQUIREMENTS, PROPOFOL, ISOFLURANE, MINIMUM ALVEOLAR CONCENTRATION

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Chicago
VEREECKE, HUGO, Johannes H Proost, Bjorn Heyse, Douglas J Eleveld, Takasumi Katoh, Martin Luginbühl, and Michel Struys. 2013. “Interaction Between Nitrous Oxide, Sevoflurane, and Opioids: a Response Surface Approach.” Anesthesiology 118 (4): 894–902.
APA
VEREECKE, H., Proost, J. H., Heyse, B., Eleveld, D. J., Katoh, T., Luginbühl, M., & Struys, M. (2013). Interaction between nitrous oxide, sevoflurane, and opioids: a response surface approach. ANESTHESIOLOGY, 118(4), 894–902.
Vancouver
1.
VEREECKE H, Proost JH, Heyse B, Eleveld DJ, Katoh T, Luginbühl M, et al. Interaction between nitrous oxide, sevoflurane, and opioids: a response surface approach. ANESTHESIOLOGY. 2013;118(4):894–902.
MLA
VEREECKE, HUGO, Johannes H Proost, Bjorn Heyse, et al. “Interaction Between Nitrous Oxide, Sevoflurane, and Opioids: a Response Surface Approach.” ANESTHESIOLOGY 118.4 (2013): 894–902. Print.
@article{3208849,
  abstract     = {Background: The interaction of sevoflurane and opioids can be described by response surface modeling using the hierarchical model. We expanded this for combined administration of sevoflurane, opioids, and 66 vol.\% nitrous oxide (N2O), using historical data on the motor and hemodynamic responsiveness to incision, the minimal alveolar concentration, and minimal alveolar concentration to block autonomic reflexes to nociceptive stimuli, respectively. 
Methods: Four potential actions of 66 vol.\% N2O were postulated: (1) N2O is equivalent to A ng/ml of fentanyl (additive); (2) N2O reduces C50 of fentanyl by factor B; (3) N2O is equivalent to X vol.\% of sevoflurane (additive); (4) N2O reduces C50 of sevoflurane by factor Y. These four actions, and all combinations, were fitted on the data using NON-MEM (version VI, Icon Development Solutions, Ellicott City, MD), assuming identical interaction parameters (A, B, X, Y) for movement and sympathetic responses. 
Results: Sixty-six volume percentage nitrous oxide evokes an additive effect corresponding to 0.27 ng/ml fentanyl (A) with an additive effect corresponding to 0.54 vol.\% sevoflurane (X). Parameters B and Y did not improve the fit. 
Conclusion: The effect of nitrous oxide can be incorporated into the hierarchical interaction model with a simple extension. The model can be used to predict the probability of movement and sympathetic responses during sevoflurane anesthesia taking into account interactions with opioids and 66 vol.\% N2O.},
  author       = {VEREECKE, HUGO and Proost, Johannes H and Heyse, Bjorn and Eleveld, Douglas J and Katoh, Takasumi and Luginb{\"u}hl, Martin and Struys, Michel},
  issn         = {0003-3022},
  journal      = {ANESTHESIOLOGY},
  keyword      = {FENTANYL,MAC,REQUIREMENTS,PROPOFOL,ISOFLURANE,MINIMUM ALVEOLAR CONCENTRATION},
  language     = {eng},
  number       = {4},
  pages        = {894--902},
  title        = {Interaction between nitrous oxide, sevoflurane, and opioids: a response surface approach},
  url          = {http://dx.doi.org/10.1097/ALN.0b013e3182860486},
  volume       = {118},
  year         = {2013},
}

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