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Probability to tolerate laryngoscopy and noxious stimulation response index as general indicators of the anaesthetic potency of sevoflurane, propofol, and remifentanil

(2016) BRITISH JOURNAL OF ANAESTHESIA. 116(5). p.624-631
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Abstract
Background: The probability to tolerate laryngoscopy (P-TOL) and its derivative, the noxious stimulation response index (NSRI), have been proposed as measures of potency of a propofol-remifentanil drug combination. This study aims at developing a triple drug interaction model to estimate the combined potency of sevoflurane, propofol, and remifentanil in terms of P-TOL. We compare the predictive performance of P-TOL and the NSRI with various anaesthetic depth monitors. Methods: Data from three previous studies (n=120) were pooled and reanalysed. Movement response after laryngoscopy was observed with different combinations of propofol-remifentanil, sevoflurane-propofol, and sevoflurane-remifentanil. A triple interaction model to estimate P-TOL was developed. The NSRI was derived from P-TOL. The ability of P-TOL and the NSRI to predict observed tolerance of laryngoscopy (TOL) was compared with the following other measures: (i) effect-site concentrations of sevoflurane, propofol, and remifentanil (Ce-SEVO, Ce-PROP, and Ce-REMI); (ii) bispectral index; (iii) two measures of spectral entropy; (iv) composite variability index; and (v) surgical pleth index. Results: Sevoflurane and propofol interact additively, whereas remifentanil interacts in a strongly synergistic manner. The effect-site concentrations of sevoflurane and propofol at a P-TOL of 50% (Ce50;SE) were 2.59 (0.13) vol % and 7.58 (0.49) mu g ml(-1). ACe(REMI) of 1.36 (0.15) ng ml-1 reduced the Ce50 of sevoflurane and propofol by 50%. The common slope factor was 5.22 (0.52). The P-TOL and NSRI predict the movement response to laryngoscopy best. Conclusions: The triple interaction model estimates the potency of any combination of sevoflurane, propofol, and remifentanil expressed as either P-TOL or NSRI.
Keywords
remifentanil, propofol, laryngoscopy, drug interactions, sevoflurane, BISPECTRAL INDEX, ISOFLURANE/OXYGEN ANESTHESIA, DRUG-INTERACTIONS, SPECTRAL ENTROPY, SURFACE MODEL, SKIN INCISION, PHARMACOKINETICS, PHARMACODYNAMICS, VARIABILITY, NOCICEPTION

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MLA
Hannivoort, LN et al. “Probability to Tolerate Laryngoscopy and Noxious Stimulation Response Index as General Indicators of the Anaesthetic Potency of Sevoflurane, Propofol, and Remifentanil.” BRITISH JOURNAL OF ANAESTHESIA 116.5 (2016): 624–631. Print.
APA
Hannivoort, L., Vereecke, H., Proost, J., Heyse, B., Eleveld, D., Bouillon, T., Struys, M., et al. (2016). Probability to tolerate laryngoscopy and noxious stimulation response index as general indicators of the anaesthetic potency of sevoflurane, propofol, and remifentanil. BRITISH JOURNAL OF ANAESTHESIA, 116(5), 624–631.
Chicago author-date
Hannivoort, LN, HEM Vereecke, JH Proost, Bjorn Heyse, DJ Eleveld, TW Bouillon, Michel Struys, and M Luginbühl. 2016. “Probability to Tolerate Laryngoscopy and Noxious Stimulation Response Index as General Indicators of the Anaesthetic Potency of Sevoflurane, Propofol, and Remifentanil.” British Journal of Anaesthesia 116 (5): 624–631.
Chicago author-date (all authors)
Hannivoort, LN, HEM Vereecke, JH Proost, Bjorn Heyse, DJ Eleveld, TW Bouillon, Michel Struys, and M Luginbühl. 2016. “Probability to Tolerate Laryngoscopy and Noxious Stimulation Response Index as General Indicators of the Anaesthetic Potency of Sevoflurane, Propofol, and Remifentanil.” British Journal of Anaesthesia 116 (5): 624–631.
Vancouver
1.
Hannivoort L, Vereecke H, Proost J, Heyse B, Eleveld D, Bouillon T, et al. Probability to tolerate laryngoscopy and noxious stimulation response index as general indicators of the anaesthetic potency of sevoflurane, propofol, and remifentanil. BRITISH JOURNAL OF ANAESTHESIA. 2016;116(5):624–31.
IEEE
[1]
L. Hannivoort et al., “Probability to tolerate laryngoscopy and noxious stimulation response index as general indicators of the anaesthetic potency of sevoflurane, propofol, and remifentanil,” BRITISH JOURNAL OF ANAESTHESIA, vol. 116, no. 5, pp. 624–631, 2016.
@article{8052701,
  abstract     = {Background: The probability to tolerate laryngoscopy (P-TOL) and its derivative, the noxious stimulation response index (NSRI), have been proposed as measures of potency of a propofol-remifentanil drug combination. This study aims at developing a triple drug interaction model to estimate the combined potency of sevoflurane, propofol, and remifentanil in terms of P-TOL. We compare the predictive performance of P-TOL and the NSRI with various anaesthetic depth monitors. 
Methods: Data from three previous studies (n=120) were pooled and reanalysed. Movement response after laryngoscopy was observed with different combinations of propofol-remifentanil, sevoflurane-propofol, and sevoflurane-remifentanil. A triple interaction model to estimate P-TOL was developed. The NSRI was derived from P-TOL. The ability of P-TOL and the NSRI to predict observed tolerance of laryngoscopy (TOL) was compared with the following other measures: (i) effect-site concentrations of sevoflurane, propofol, and remifentanil (Ce-SEVO, Ce-PROP, and Ce-REMI); (ii) bispectral index; (iii) two measures of spectral entropy; (iv) composite variability index; and (v) surgical pleth index. 
Results: Sevoflurane and propofol interact additively, whereas remifentanil interacts in a strongly synergistic manner. The effect-site concentrations of sevoflurane and propofol at a P-TOL of 50% (Ce50;SE) were 2.59 (0.13) vol % and 7.58 (0.49) mu g ml(-1). ACe(REMI) of 1.36 (0.15) ng ml-1 reduced the Ce50 of sevoflurane and propofol by 50%. The common slope factor was 5.22 (0.52). The P-TOL and NSRI predict the movement response to laryngoscopy best. 
Conclusions: The triple interaction model estimates the potency of any combination of sevoflurane, propofol, and remifentanil expressed as either P-TOL or NSRI.},
  author       = {Hannivoort, LN and Vereecke, HEM and Proost, JH and Heyse, Bjorn and Eleveld, DJ and Bouillon, TW and Struys, Michel and Luginbühl, M},
  issn         = {0007-0912},
  journal      = {BRITISH JOURNAL OF ANAESTHESIA},
  keywords     = {remifentanil,propofol,laryngoscopy,drug interactions,sevoflurane,BISPECTRAL INDEX,ISOFLURANE/OXYGEN ANESTHESIA,DRUG-INTERACTIONS,SPECTRAL ENTROPY,SURFACE MODEL,SKIN INCISION,PHARMACOKINETICS,PHARMACODYNAMICS,VARIABILITY,NOCICEPTION},
  language     = {eng},
  number       = {5},
  pages        = {624--631},
  title        = {Probability to tolerate laryngoscopy and noxious stimulation response index as general indicators of the anaesthetic potency of sevoflurane, propofol, and remifentanil},
  url          = {http://dx.doi.org/10.1093/bja/aew060},
  volume       = {116},
  year         = {2016},
}

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