Modeling of Recovery Profiles in Mentally Disabled and Intact Patients after Sevoflurane Anesthesia; A Pharmacodynamic Analysis
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: Mentally disabled patients show different recovery profiles compared to normal patients after general anesthesia. However, the relationship of dose-recovery profiles of mentally disabled patients has never been compared to that of normal patients. Materials and Methods: Twenty patients (10 mentally disabled patients and 10 mentally intact patients) scheduled to dental surgery under general anesthesia was recruited. Sevoflurane was administered to maintain anesthesia during dental treatment. At the end of the surgery, sevoflurane was discontinued. End-tidal sevoflurane and recovery of consciousness (ROC) were recorded after sevoflurane discontinuation. The pharmacodynamic relation between the probability of ROC and end-tidal sevoflurane concentration was analyzed using NONMEM software (version VII). Results: End-tidal sevoflurane concentration associated with 50% probability of ROC (C50) and γ value were lower in the mentally disabled patients (C50=0.37 vol %, γ=16.5 in mentally intact patients, C50=0.19 vol %, γ=4.58 in mentally disabled patients). Mentality was a significant covariate of C50 for ROC and γ value to pharmacodynamicmodel. Conclusion: A sigmoid Emanx model explains the pharmacodynamicrelationship between end-tidal sevoflurane concentration and ROC. Mentally disabled patients may recover slower from anesthesia at lower sevoflurane concentrationat ROC an compared to normal patients.
Abstract
Purpose: Mentally disabled patients show different recovery profiles compared to normal patients after general anesthesia. However, the relationship of dose-recovery profiles of mentally disabled patients has never been compared to that of normal patients. Materials and Methods: Twenty patients (10 mentally disabled patients and 10 mentally intact patients) scheduled to dental surgery under general anesthesia was recruited. Sevoflurane was administered to maintain anesthesia during dental treatment. At the end of the surgery, sevoflurane was discontinued. End-tidal sevoflurane and recovery of consciousness (ROC) were recorded after sevoflurane discontinuation. The pharmacodynamic relation between the probability of ROC and end-tidal sevoflurane concentration was analyzed using NONMEM software (version VII). Results: End-tidal sevoflurane concentration associated with 50% probability of ROC (C50) and γ value were lower in the mentally disabled patients (C50=0.37 vol %, γ=16.5 in mentally intact patients, C50=0.19 vol %, γ=4.58 in mentally disabled patients). Mentality was a significant covariate of C50 for ROC and γ value to pharmacodynamicmodel. Conclusion: A sigmoid Emanx model explains the pharmacodynamicrelationship between end-tidal sevoflurane concentration and ROC. Mentally disabled patients may recover slower from anesthesia at lower sevoflurane concentrationat ROC an compared to normal patients.
참고문헌 (19)
- Larsen B, "Recovery of cognitive function after remifentanil-propofol anesthesia: a comparison with desflurane and sevoflurane anesthesia", Anesth Analg, 90, pp.168~174 (2000)
- Escribano-Hernández A, "Evaluation of satisfaction among relatives of mentally disabled patients who were users of a dental care protocol under general anaesthesia", Med Oral Patol Oral Cir Bucal, 17, pp.e83~e88 (2012)
- Maestre C, "The use of general anaesthesia for tooth extraction in young handicapped adults in France", Br Dent J, 180, pp.297~302 (1996)
- Hung WT, "Anesthetic management of dental procedures in mentally handicapped patients", Acta Anaesthesiol Sin, 41, pp.65~70 (2003)
- Schraag S, "The performance of electroencephalogram bispectral index and auditory evoked potential index to predict loss of consciousness during propofol infusion", Anesth Analg, 89, pp.1311~1315 (1999)
- Nickalls RW, "Age-related iso-MAC charts for isoflurane, sevoflurane and desflurane in man", Br J Anaesth, 91, pp.170~174 (2003)
- Chernik DA, "Validity and reliability of the Observer’s Assessment of Alertness", Sedation Scale: study with intravenous midazolam, 1990, pp.10, 244~251
- Koo BN, "A pharmacodynamic analysis of factors affecting recovery from anesthesia with propofol-remifentanil target controlled infusion", ACTA PHARMACOLOGICA SINICA, 33(8), pp.1080~1084 (2012), ACTA PHARMACOLOGICA SINICA
- Lu W, "Reliability of pharmacodynamic analysis by logistic regression: mixed-effects modeling", Anesthesiology, 99, pp.1255~1262 (2003)
- "Reliability of pharmacodynamic analysis by logistic regression: a computer simulation study", Anesthesiology, 92, pp.985~992 (2000)
- Katoh T, "Influence of age on awakening concentrations of sevoflurane and isoflurane", Anesth Analg, 76, pp.348~352 (1993)
- Inomata S, "The effects of clonidine premedication on sevoflurane requirements and anesthetic induction time", Anesth Analg, 89, pp.204~208 (1999)
- Katoh T, "The effects of fentanyl on sevoflurane requirements for loss of consciousness and skin incision", Anesthesiology, 88, pp.18~24 (1998)
- Kihara S, "The awakening concentration of sevoflurane in children", Anesth Analg, 91, pp.305~308 (2000)
- Cechova S, "Inhibition of glutamate transporters increases the minimum alveolar concentration for isoflurane in rats", Br J Anaesth, 97, pp.192~195 (2006)
- Vadivelu N, "Special anesthetic concerns in mentally handicapped institutionalized patients undergoing gynecological procedures in an outpatient setting", Conn Med, 68, pp.359~362 (2004)
- Hwang E, "Characterization of Phase Transition in the Thalamocortical System during Anesthesia-Induced Loss of Consciousness", PLOS ONE, 7(12), pp.e50580~ (2012), PUBLIC LIBRARY SCIENCE
- Kroon T, "Investigating mechanisms underlying neurodevelopmental phenotypes of autistic and intellectual disability disorders: a perspective", Front Syst Neurosci, 7, pp.75~ (2013)
- Purohit BM, "Oral health status and treatment needs of children attending special schools in South India: a comparative study", Spec Care Dentist, 30, pp.235~241 (2010)