B. Rehberg, N. Wickboldt, C. Juillet, G. Savoldelli 

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Presentation transcript:

Can remifentanil use in obstetrics be improved by optimal patient-controlled analgesia bolus timing?  B. Rehberg, N. Wickboldt, C. Juillet, G. Savoldelli  British Journal of Anaesthesia  Volume 114, Issue 2, Pages 281-289 (February 2015) DOI: 10.1093/bja/aeu368 Copyright © 2015 The Author(s) Terms and Conditions

Fig 1 Original tracings of the handheld dynamometer for an exemplary parturient (continuous line) in parallel with the external tocography recording (dashed line). Handgrip force is given in newtons and time in seconds. The baseline limit (dotted line) is determined by averaging baseline fluctuations of the dynamometer signal. British Journal of Anaesthesia 2015 114, 281-289DOI: (10.1093/bja/aeu368) Copyright © 2015 The Author(s) Terms and Conditions

Fig 2 Time series data of the inter-contraction time interval from four patients (coded t2, t4, t6, t25) with uninterrupted time series of more than 200 min. British Journal of Anaesthesia 2015 114, 281-289DOI: (10.1093/bja/aeu368) Copyright © 2015 The Author(s) Terms and Conditions

Fig 3 Modelled remifentanil plasma and effect-site concentration during a series of contractions of an exemplary patient. Painful contractions are indicated by dark grey bars. Different modes of bolus application are compared: (a, upper set of traces) the remifentanil bolus is administered at the beginning of the pain sensation (traditional PCA setting); (b, second set of traces) in an ideal situation where remifentanil effect-site concentration is optimized to coincide with the pain sensation; (c, third set of traces) automatic bolus application with prediction of the time point by a moving average algorithm of the last three contraction intervals. The arrow marks contractions predicted by the model which do not occur in reality. British Journal of Anaesthesia 2015 114, 281-289DOI: (10.1093/bja/aeu368) Copyright © 2015 The Author(s) Terms and Conditions

Fig 4 Comparison of the different modes of remifentanil bolus application (PCA, bolus is administered at the beginning of a contraction; BEST, bolus is administered at the ideal time point to maximize efficacy; MEAN3, bolus is administered at the time point predicted by a three-point moving average model; ETS, bolus is administered at the time point predicted by an ETS model) in terms of efficacy, safety, and effect-site concentration at the beginning of pain during a contraction (‘instantaneous’). Shown are simulated mean effect-site concentrations for the four exemplary patients with time series of more than 200 min. Box plots denote outliersmin <Q1 −1.5 IQR<Q1<Q2<Q3<Q3+1.5 IQR <outliersmax with IQR=Q3−Q1. British Journal of Anaesthesia 2015 114, 281-289DOI: (10.1093/bja/aeu368) Copyright © 2015 The Author(s) Terms and Conditions