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Testing and modelling the interaction of alfentanil and propofol on the EEG

Published online by Cambridge University Press:  30 June 2005

H. Schwilden ,
J. Fechner ,
S. Albrecht ,
W. Hering ,
H. Ihmsen  and
J. Schüttler
H. Schwilden
Affiliation:
Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Anaesthesiology, Erlangen, Germany
J. Fechner
Affiliation:
Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Anaesthesiology, Erlangen, Germany
S. Albrecht
Affiliation:
Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Anaesthesiology, Erlangen, Germany
W. Hering
Affiliation:
Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Anaesthesiology, Erlangen, Germany
H. Ihmsen
Affiliation:
Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Anaesthesiology, Erlangen, Germany
J. Schüttler
Affiliation:
Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Anaesthesiology, Erlangen, Germany
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Extract

Summary

Background and objective: For total intravenous anaesthesia an opioid is often combined with a hypnotic. A supra-additive interaction has been reported for clinical signs such as loss of consciousness or loss of the eyelash reflex. This study investigated the type of interaction of alfentanil and propofol on the electroencephalogram.

Methods: Twenty patients scheduled for abdominal surgery were enrolled in the study. Anaesthesia was induced and maintained with alfentanil and propofol. Each patient received a target-controlled infusion of alfentanil. Three target concentrations of 150, 225 and 300 ng mL−1 were applied to each patient in random order. Propofol was added to the alfentanil infusion by a feedback system. The set point was the range of 1.5–2.5 Hz median frequency of the electroencephalogram. Four arterial blood samples were taken within the last 20 min of each period. The mean drug concentrations were used to determine the type of interaction and an isobole was estimated by fitting Bernstein spline functions to the data.

Results: In 17 patients, all three alfentanil target concentrations could be administered. The test for supra-additivity as well as the isobole construction resulted in an additive type of interaction. The line of additivity cA/cA0 + cP/cP0 = 1 was best fitted for the values (standard deviation) cA0 = 1240 (51) ng mL−1 and cP0 = 5.21 (0.36) μg mL−1.

Conclusions: The type of interaction between alfentanil and propofol on the electroencephalogram in the investigated dose range is additive. This gives the freedom and need to select the appropriate dosing ratio of alfentanil and propofol by other considerations.

Keywords

ANAESTHESIA, INTRAVENOUSANAESTHETICS, INTRAVENOUS, propofolCHEMICAL AND PHARMACOLOGICAL PHENOMENA, drug interactions, drug synergismNARCOTICS, alfentanil
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 5 , May 2003 , pp. 363 - 372
Copyright
2003 European Society of Anaesthesiology

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