Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:2.3.1.177 (BIS)
 957 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Remifentanil has important side effects and it is not easy to know what remifentanil concentrations should be used during different endpoints of anaesthesia. We analyzed the remifentanil predicted effect-site concentrations (RemiCe) at different events during neurosurgical procedures and assessed if the concentrations used were clinically adequate. BIS and haemodynamic parameters were collected every 5 seconds. Predicted cerebral concentration of propofol (PropCe) and RemiCe were analyzed immediately prior to respective stimulus, and 30, 60 and 90 seconds after. RemiCe were 2.2 +/- 0.3, 6 +/- 2.6 and 2.2 +/- 0.9 ng ml(-1) at intubation, incision and extubation, respectively. PropCe observed in the same periods were 5 +/- 1, 2.6 +/- 0.9 and 1 +/- 0.3 microg ml(-1), also respectively. The remifentanil concentrations used in our patients were lower than reported concentrations, while being clinically adequate to minimize the haemodynamic response to stimulation.
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PMID:Practical aspects of the use of target controlled infusion with remifentanil in neurosurgical patients: predicted cerebral concentrations at intubation, incision and extubation. 1706 38

Anesthesia with remifentanil can be induced either with slow bolus administration (1 microg x kg(-1) for over 60 sec) or with starting the continuous infusion (0.5-1 microg x kg(-1) x hr(-1)) combined with a standard hypnotic agent (i.e. propofol, thiamylal, sevoflurane or isoflurane). According to the patient's requirement observing hemodynamics, the infusion rate of remifentanil should be titrated after tracheal intubation. Because of the rapid onset and short duration of its action, the infusion rate can be increased or decreased safely. Remifentanil is an effective agent in obtunding the stress response to tracheal intubation and surgery. Due to its synergistic effect with hypnotic agents, sevoflurane, isoflurane or propofol, it should be reduced carefully to prevent excessive depth of anesthesia. BIS values should be monitored closely. Remifentanil seems to be as potent as fentanyl. Prior to emergence from general anesthesia using remifentanil, postoperative pain management should be considered. NSAIDs or a long acting opioid could be administered.
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PMID:[Clinical usefulness of remifentanil]. 1802 98

The paper presents a feasibility study on the use of Model based Predictive control (MPC) to regulate the level of Depth of Anaesthesia (DoA) when measured by the BIS index. Pharmacokinetic/pharmacodynamic nonlinear models of DoA when Propofol and Remifentanil are used as hypnotic and analgesic drugs are linearized around the desired working point for DoA in order to obtain a linear state-space model coupled with an extra integrator to include integral action in the control. This state-space model is then used in a MPC algorithm. The main contribution of the paper consists in the characterization of the influence of the different design parameters in the MPC performance when controlling DoA.
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PMID:Model predictive control of depth of anaesthesia: guidelines for controller configuration. 1916 41