Spinal Fusion Clinical Trial
Official title:
An Evaluation of RemifentanilPropofol Infusion in Pediatric Spinal Surgery
Total intravenous anesthesia(TIVA) is a commonly used anesthetic technique. Although TIVA can be accomplished with a variety of drug combinations, infusions of Propofol and Remifentanil are often used with dosage adjusted manually by the anesthesia provider.The pharmacokinetics of these drugs are well understood, and that knowledge has led to the development of computer controlled infusion pumps that can administer the drugs based upon pharmacokinetic models. Computer controlled infusion schemes automatically adjust the drug administration based upon pharmacokinetic models which typically dictate a tapering infusion scheme. When one considers the dosage of a computer controlled infusion it is obvious that manually imitating a similar scheme may be difficult.This study will evaluate manually controlled infusion schemes using the models built into the Applied Medical Visualizations (Medvis) display and compare the manual dosage schemes to the predicted effect site concentrations and pharmacodynamic effect.
During Total intravenous anesthesia (TIVA), the anesthetic propofol and the opioid
remifentanil are often used together. Previous studies have demonstrated the synergy between
these combinations of medications. From these data, drug interaction models have been
developed to pair drug effect-site concentrations with event markers of interest to the
clinical anesthesiologist. For example, the amount of remifentanil and propofol typically
required during the induction of anesthesia to cause loss of responsiveness to verbal or
moderate stimuli has been studied. Likewise, the blood concentration levels present during
emergence from anesthesia have been explored describing levels typically present for
patients to return to consciousness.
The purpose of this study is to retrospectively analyze the infusion doses of both
remifentanil and propofol for pediatric patients undergoing spinal fusion surgery at CHOP.
These data will be applied to the pharmacokinetic models to determine the predicted effect
site concentration, and the relationship of that concentration to the 50% and 95% doses as
predicted by the model.
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Observational Model: Cohort, Time Perspective: Retrospective
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