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A response surface model approach for continuous measures of hypnotic and analgesic effect during sevoflurane-remifentanil interaction: quantifying the pharmacodynamic shift evoked by stimulation

(2014) ANESTHESIOLOGY. 120(6). p.1390-1399
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Abstract
Background: The authors studied the interaction between sevoflurane and remifentanil on bispectral index (BIS), state entropy (SE), response entropy (RE), Composite Variability Index, and Surgical Pleth Index, by using a response surface methodology. The authors also studied the influence of stimulation on this interaction. Methods: Forty patients received combined concentrations of remifentanil (0 to 12 ng/ml) and sevoflurane (0.5 to 3.5 vol%) according to a crisscross design (160 concentration pairs). During pseudo–steady-state anesthesia, the pharmacodynamic measures were obtained before and after a series of noxious and nonnoxious stimulations. For the “prestimulation” and “poststimulation” BIS, SE, RE, Composite Variability Index, and Surgical Pleth Index, interaction models were applied to find the best fit, by using NONMEM 7.2.0. (Icon Development Solutions, Hanover, MD). Results: The authors found an additive interaction between sevoflurane and remifentanil on BIS, SE, and RE. For Composite Variability Index, a moderate synergism was found. The comparison of pre- and poststimulation data revealed a shift of C50SEVO for BIS, SE, and RE, with a consistent increase of 0.3 vol%. The Surgical Pleth Index data did not result in plausible parameter estimates, neither before nor after stimulation. Conclusions: By combining pre- and poststimulation data, interaction models for BIS, SE, and RE demonstrate a consistent influence of “stimulation” on the pharmacodynamic relationship between sevoflurane and remifentanil. Significant population variability exists for Composite Variability Index and Surgical Pleth Index.
Keywords
BISPECTRAL INDEX, ANESTHETIC DRUG-INTERACTIONS, GENERAL-ANESTHESIA, PROPOFOL, PHARMACOKINETICS, ENTROPY

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MLA
Heyse, Bjorn et al. “A Response Surface Model Approach for Continuous Measures of Hypnotic and Analgesic Effect During Sevoflurane-remifentanil Interaction: Quantifying the Pharmacodynamic Shift Evoked by Stimulation.” ANESTHESIOLOGY 120.6 (2014): 1390–1399. Print.
APA
Heyse, B., Proost, J. H., Hannivoort, L. N., Eleveld, D. J., Luginbühl, M., Struys, M., & VEREECKE, H. (2014). A response surface model approach for continuous measures of hypnotic and analgesic effect during sevoflurane-remifentanil interaction: quantifying the pharmacodynamic shift evoked by stimulation. ANESTHESIOLOGY, 120(6), 1390–1399.
Chicago author-date
Heyse, Bjorn, Johannes H Proost, Laura N Hannivoort, Douglas J Eleveld, Martin Luginbühl, Michel Struys, and HUGO VEREECKE. 2014. “A Response Surface Model Approach for Continuous Measures of Hypnotic and Analgesic Effect During Sevoflurane-remifentanil Interaction: Quantifying the Pharmacodynamic Shift Evoked by Stimulation.” Anesthesiology 120 (6): 1390–1399.
Chicago author-date (all authors)
Heyse, Bjorn, Johannes H Proost, Laura N Hannivoort, Douglas J Eleveld, Martin Luginbühl, Michel Struys, and HUGO VEREECKE. 2014. “A Response Surface Model Approach for Continuous Measures of Hypnotic and Analgesic Effect During Sevoflurane-remifentanil Interaction: Quantifying the Pharmacodynamic Shift Evoked by Stimulation.” Anesthesiology 120 (6): 1390–1399.
Vancouver
1.
Heyse B, Proost JH, Hannivoort LN, Eleveld DJ, Luginbühl M, Struys M, et al. A response surface model approach for continuous measures of hypnotic and analgesic effect during sevoflurane-remifentanil interaction: quantifying the pharmacodynamic shift evoked by stimulation. ANESTHESIOLOGY. 2014;120(6):1390–9.
IEEE
[1]
B. Heyse et al., “A response surface model approach for continuous measures of hypnotic and analgesic effect during sevoflurane-remifentanil interaction: quantifying the pharmacodynamic shift evoked by stimulation,” ANESTHESIOLOGY, vol. 120, no. 6, pp. 1390–1399, 2014.
@article{4411727,
  abstract     = {Background: The authors studied the interaction between sevoflurane and remifentanil on bispectral index (BIS), state entropy (SE), response entropy (RE), Composite Variability Index, and Surgical Pleth Index, by using a response surface methodology. The authors also studied the influence of stimulation on this interaction.
Methods: Forty patients received combined concentrations of remifentanil (0 to 12 ng/ml) and sevoflurane (0.5 to 3.5 vol%) according to a crisscross design (160 concentration pairs). During pseudo–steady-state anesthesia, the pharmacodynamic measures were obtained before and after a series of noxious and nonnoxious stimulations. For the “prestimulation” and “poststimulation” BIS, SE, RE, Composite Variability Index, and Surgical Pleth Index, interaction models were applied to find the best fit, by using NONMEM 7.2.0. (Icon Development Solutions, Hanover, MD).
Results: The authors found an additive interaction between sevoflurane and remifentanil on BIS, SE, and RE. For Composite Variability Index, a moderate synergism was found. The comparison of pre- and poststimulation data revealed a shift of C50SEVO for BIS, SE, and RE, with a consistent increase of 0.3 vol%. The Surgical Pleth Index data did not result in plausible parameter estimates, neither before nor after stimulation.
Conclusions: By combining pre- and poststimulation data, interaction models for BIS, SE, and RE demonstrate a consistent influence of “stimulation” on the pharmacodynamic relationship between sevoflurane and remifentanil. Significant population variability exists for Composite Variability Index and Surgical Pleth Index.},
  author       = {Heyse, Bjorn and Proost, Johannes H and Hannivoort, Laura N and Eleveld, Douglas J and Luginbühl, Martin and Struys, Michel and VEREECKE, HUGO},
  issn         = {0003-3022},
  journal      = {ANESTHESIOLOGY},
  keywords     = {BISPECTRAL INDEX,ANESTHETIC DRUG-INTERACTIONS,GENERAL-ANESTHESIA,PROPOFOL,PHARMACOKINETICS,ENTROPY},
  language     = {eng},
  number       = {6},
  pages        = {1390--1399},
  title        = {A response surface model approach for continuous measures of hypnotic and analgesic effect during sevoflurane-remifentanil interaction: quantifying the pharmacodynamic shift evoked by stimulation},
  url          = {http://dx.doi.org/10.1097/ALN.0000000000000180},
  volume       = {120},
  year         = {2014},
}

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