Abstract:
BACKGROUND:Pathophysiologic changes in children with congenital heart disease may alter the effect of drugs by influencing the pharmacokinetics (PK). Considering the limited literature that describes the PK of etomidate in pediatric patients, especially in those with tetralogy of Fallot (TOF), our aim was to characterize the PK of etomidate and explore the effects of TOF. METHODS:Twenty-nine pediatric patients (15 with TOF and 14 with normal cardiac anatomy) scheduled to undergo elective surgery under general anesthesia were recruited in the study. All children received etomidate 60 μg/kg/min intravenously until a bispectral index of ≤50 was reached for 5 seconds during anesthesia induction. Arterial blood samples were drawn and analyzed. Population analysis was performed by using NONMEM to define PK characteristics. The estimates were standardized to a 70-kg adult using a per-kilogram model. RESULTS:Data consisting of 244 samples from 29 children with a mean age of 236 days (range, 86-360 days) were used, including a TOF group with a mean age of 250 days (range, 165-360 days) and a normal cardiac anatomy group with a mean age of 221 days (range, 86-360 days). A 3-compartment disposition model was best fitted to describe the PK of etomidate. The introduction of TOF as a covariate for systemic clearance (Cl1) improved the model and resulted in a significant reduction of objective function (Δobjective function = -7.33; P = .0068), which means that TOF was a significant covariate of Cl1, and the etomidate Cl1 in children with TOF (1.67 × (weight [WT]/70 kg) L/min) was lower than those with normal cardiac anatomy (2.28 × (WT/70 kg) L/min). Other PK parameter values were as follows: V1 = 8.05 × (WT/70 kg) L; V2 = 13.7 × (WT/70 kg) L; V3 = 41.3 × (WT/70 kg) L; Cl2 = 3.35 × (WT/70 kg) L/min; Cl3 = 0.563 × (WT/70 kg) L/min. CONCLUSIONS:A decreased systemic clearance for etomidate in children with TOF resulted in a lower required infusion rate and variation with time to achieve the same plasma concentration and maintain an equivalent target concentration or have longer sedation and recovery times after bolus or continuous infusion than normal children.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Shen Y,Cai MH,Ji W,Bai J,Huang Y,Sun Y,Lin L,Niu J,Zhang MZdoi
10.1213/ANE.0000000000001477subject
Has Abstractpub_date
2016-09-01 00:00:00pages
722-30issue
3eissn
0003-2999issn
1526-7598pii
00000539-201609000-00025journal_volume
123pub_type
杂志文章abstract::In the past, it was common practice to use a high tidal volume (VT) during intraoperative ventilation, because this reduced the need for high oxygen fractions to compensate for the ventilation-perfusion mismatches due to atelectasis in a time when it was uncommon to use positive end-expiratory pressure (PEEP) in the o...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000005187
更新日期:2020-12-01 00:00:00
abstract:UNLABELLED:We used a double-blind design to study urodynamic changes induced by mu-agonists (fentanyl, morphine), a partial mu-agonist antagonist (buprenorphine), a putative mu-antagonist, kappa-agonist (nalbuphine), and ketoprofen, an injectable nonsteroidal antiinflammatory drug. Men (20-55 yr old) were randomly assi...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199808000-00042
更新日期:1998-08-01 00:00:00
abstract:BACKGROUND:Midazolam is the most commonly used premedication in children. It has been shown to be more effective than parental presence or placebo in reducing anxiety and improving compliance at induction of anesthesia. Clonidine, an alpha(2) agonist, has been suggested as an alternative. Dexmedetomidine is a more alph...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ane.0b013e31816c8929
更新日期:2008-06-01 00:00:00
abstract::The effects of narcotic agents and two inhalation anesthetics on intrabiliary pressure (IBP) were measured before and after morphine (0.2 mg/kg), meperidine (2 mg/kg), fentanyl (0.002 mg/kg), or pentazocine (1 mg/kg) given intramuscularly to guinea pigs, and after halothane (0.5, 1.0, 1.5, or 2.0 MAC) or enflurane (sa...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1979-03-01 00:00:00
abstract::We investigated the characteristics of hypoxemic fetoplacental vasoconstriction (HFPV) in the dual perfused, single isolated human placental cotyledon. Fetal arterial blood pressures (FAP) were measured in four cotyledons (Group 1) equilibrated with 21% oxygen (O2), 5% carbon dioxide (CO2), and nitrogen (N2) [control]...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000222468.76942.d8
更新日期:2006-08-01 00:00:00
abstract::To determine the effect of liver disease on the pharmacokinetics of rocuronium, the authors administered 0.6 mg/kg (twice the ED95) to 10 patients with liver disease and compared these results to values in 10 healthy surgical patients. Anesthesia was induced with thiopental and maintained with isoflurane (0.9%-1.1% en...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199504000-00018
更新日期:1995-04-01 00:00:00
abstract:BACKGROUND:District-level hospitals (DLHs) are the main providers of surgical services for rural populations in Sub-Saharan Africa (SSA). Skilled teams are essential for surgical care, and gaps in anesthesia impact negatively on surgical capacity and outcomes. This study, from a baseline of a project scaling-up access ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000004363
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:I.v. injection of propofol during anesthetic induction induces pain. Ketamine has been shown to reduce injection pain. In this study, we established the optimal dose of ketamine to prevent the pain of injection with propofol. METHODS:Two hundred forty patients presenting for elective surgery were randomly a...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/01.ane.0000243334.83816.53
更新日期:2006-12-01 00:00:00
abstract::The anesthesia machine check is an integral part of the anesthesiologist's daily routine. It is standard operating procedure to check the high- and low-pressure systems of the machine as well as other integral parts that are accessible. Many new anesthesia machines offer a self-testing capability, but older ones with ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ANE.0000175210.13435.82
更新日期:2005-09-01 00:00:00
abstract:UNLABELLED:Because inhibition of voltage-dependent Ca(2+) channels can be a mechanism underlying general anesthesia, we examined sensitivities to propofol and halothane in mice lacking the R-type (Ca(v)2.3) channel widely expressed in neurons. Sleep time after propofol injection (26 mg/kg IV) and halothane MAC(RR) and ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000065548.83253.5c
更新日期:2003-07-01 00:00:00
abstract:BACKGROUND:Insufficient fixation of an epidural catheter may result in migration of the catheter and eventual catheter failure. However, the best fixation method remains to be established. Aron Alpha A (2-ethyl cyanoacrylate) adhesive is approved for clinical use and can be used for surgical adhesion to both skin and b...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000003326
更新日期:2019-07-01 00:00:00
abstract:UNLABELLED:Although acute tolerance to analgesia develops rapidly with remifentanil, it is unknown whether acute tolerance also develops to its nonanalgesic effects. We investigated the analgesic and cardiorespiratory effects of remifentanil during a continuous infusion in a rabbit model. Ten tracheotomized New Zealand...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000083370.80416.38
更新日期:2003-11-01 00:00:00
abstract::Isoflurane-oxygen was given for induction and maintenance of anesthesia to ten patients having coronary artery bypass grafts. All had preserved ventricular function without hypertension or other cardiac lesions; treatment with beta-blocking drugs was maintained until the operation in all patients. Cardiac output, arte...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1986-01-01 00:00:00
abstract:BACKGROUND:The Perioperative Surgical Home (PSH) seeks to remedy the currently highly fragmented and expensive perioperative care in the United States. The 2 specific aims of this health services research study were to assess the association between the preoperative and postoperative elements of an initial PSH model an...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000001743
更新日期:2017-05-01 00:00:00
abstract::The electroencephalograms of seven elderly (70-85 years) and seven younger patients (23-31 years) anesthetized with a concentration of isoflurane sufficient to produce burst suppression were studied. Anesthesia in these unpremedicated subjects was induced by inhalation of nitrous oxide, isoflurane, and oxygen. Trachea...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1989-01-01 00:00:00
abstract::A randomized, single-blind trial of two spinal anesthetic solutions for outpatient laparoscopy was conducted to compare intraoperative conditions and postoperative recovery. Thirty women (ASA physical status I and II) were assigned to one of two groups. Group I patients received a small-dose hypobaric solution of 1% l...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000539-199701000-00011
更新日期:1997-01-01 00:00:00
abstract::Forty neonates delivered by cesarean section were studied, half being delivered of mothers in whom anesthesia was induced with midazolam (0.3 mg/kg intravenously) and half of mothers given thiopental (4 mg/kg). At delivery, blood samples from mother and the umbilical vein were drawn for determination of plasma concent...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1989-03-01 00:00:00
abstract::The ideal choice of a priming solution of the cardiopulmonary bypass (CPB) and its influence on the hemostatic system are not clear. Addition of albumin was reported to inhibit platelet damaging by blood-surface interactions ("coating"). To explore this possibility in 60 consecutive male patients undergoing elective a...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验,收录出版
doi:10.1213/00000539-199202000-00008
更新日期:1992-02-01 00:00:00
abstract::The brain is one of the most metabolically active organs in the body. The brain's high energy demand associated with wakefulness persists during rapid eye movement sleep, and even during non-rapid eye movement sleep, cerebral oxygen consumption is only reduced by 20%. The active bioenergetic state parallels metabolic ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/ANE.0000000000004069
更新日期:2019-04-01 00:00:00
abstract::Near-infrared spectroscopy (NIRS) is a noninvasive optical technique to monitor cerebral oxygen saturation at the bedside. Despite its applicability, NIRS has had limited clinical use because of concerns about accuracy, noted by intersubject variability in slope and intercept of the line between NIRS- and weighted-ave...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199706000-00023
更新日期:1997-06-01 00:00:00
abstract:BACKGROUND:N-methyl-D-aspartate receptor (NMDARs)-dependent central sensitization plays an important role in cancer pain. Binding of NMDAR subunit 2B (NR2B) by postsynaptic density protein-95 (PSD-95) can couple NMDAR activity to intracellular enzymes, such as neuronal nitric oxide synthase (nNOS), facilitate downstrea...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0000000000000202
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:The arterial pulse oximeter, which was introduced clinically in the 1970s, is a convenient, useful, and now ubiquitous anesthesia monitor. Unfortunately, although percent saturation of arterial hemoglobin is, along with cardiac output and concentration of hemoglobin, one of 3 components of oxygen delivery, i...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182166a26
更新日期:2011-06-01 00:00:00
abstract:UNLABELLED:Clinical and basic science studies suggest that spinal alpha-2-adrenergic receptor agonists and local anesthetics produce analgesia, but interaction between alpha-2-adrenergic receptor agonists and local anesthetics in the persistent pain model has not been examined. In the present study, using isobolographi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200103000-00034
更新日期:2001-03-01 00:00:00
abstract::The purpose of these experiments was to analyze the cerebrovascular and cerebral metabolic effects of midazolam, a short-acting water-soluble benzodiazepine, and to investigate its interaction with alcohol in rats. A benzodiazepine antagonist, 3-carbo-t-butoxy-beta-carboline (beta-CCT), was used to test the role of th...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1985-02-01 00:00:00
abstract::The traditional tests that have been used for the past 30 yr to determine plasma cholinesterase phenotype--measurement of esterase activity with a variety of substrates, dibucaine inhibition, fluoride inhibition, and Ro2-0683 inhibition--are inadequate for identifying some variants of this enzyme and leave many cases ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/00000539-199377020-00027
更新日期:1993-08-01 00:00:00
abstract:UNLABELLED:This study was designed to determine if, and to what extent, antithrombin III (AT) levels affect the response of the activated clotting time (ACT) to heparin in concentrations used during cardiac surgery, and to characterize the relationship between AT levels and markers of activation of coagulation during c...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199709000-00005
更新日期:1997-09-01 00:00:00
abstract:BACKGROUND:Chemical pleurodesis causes severe pain, prompting physicians to perform thoracoscopic talc poudrage under general or neuroleptanalgesia. We describe a novel method for pain control in five patients with pneumothoraces and severe chronic obstructive pulmonary disease. METHODS:Patients were premedicated with...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ane.0000249046.02025.ef
更新日期:2007-01-01 00:00:00
abstract:IMPLICATIONS:Entrapment of a guidewire in the vena cava filter during central venous catheter placement is a newly recognized complication. Complex techniques have been described to free the guidewire. We describe a simple in situ technique that may free the guidewire without the application of complex techniques. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200208000-00010
更新日期:2002-08-01 00:00:00
abstract::The purpose of this canine study was to examine the cerebral vascular and metabolic effects of adding nitrous oxide to isoflurane from 1.4% expired (1 MAC) up to a concentration giving an isoelectric electroencephalogram (EEG). Cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRO2) were determined us...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/00000539-199101000-00013
更新日期:1991-01-01 00:00:00
abstract::Blind oral intubation using the Augustine Guide is helpful for intubating the trachea of patients presenting with difficult airways. This device has been modified by adding a fiberoptic scope with a built-in battery-powered light. We studied this Augustine Scope in 104 patients (Group AS) and compared the results with...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-199703000-00026
更新日期:1997-03-01 00:00:00