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Remifentanil–midazolam sedation for paediatric patients receiving mechanical ventilation after cardiac surgery†  A.E. Rigby-Jones, M.J. Priston, J.R.

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Presentation on theme: "Remifentanil–midazolam sedation for paediatric patients receiving mechanical ventilation after cardiac surgery†  A.E. Rigby-Jones, M.J. Priston, J.R."— Presentation transcript:

1 Remifentanil–midazolam sedation for paediatric patients receiving mechanical ventilation after cardiac surgery†  A.E. Rigby-Jones, M.J. Priston, J.R. Sneyd, A.P. McCabe, G.I. Davis, M.A. Tooley, G.C. Thorne, A.R. Wolf  British Journal of Anaesthesia  Volume 99, Issue 2, Pages (August 2007) DOI: /bja/aem135 Copyright © 2007 British Journal of Anaesthesia Terms and Conditions

2 Fig 1 Summary of the drug infusion and blood-sampling schedules. The solid line shows the remifentanil infusion scheme during our study (time = 0 indicates the beginning of the remifentanil infusion). The broken line represents the midazolam infusion rate. The black markers show typical blood-sampling time points. Three samples were collected during the first 25 min of remifentanil infusion. A further three samples were collected during the 20-min period after the first reduction in remifentanil infusion rate. Additional samples were obtained 20 min after the second and subsequent reductions in the remifentanil infusion rate and at the point of arousal. British Journal of Anaesthesia  , DOI: ( /bja/aem135) Copyright © 2007 British Journal of Anaesthesia Terms and Conditions

3 Fig 2 Mean Comfort scores in children undergoing artificial ventilation after cardiac surgery. Remifentanil infusion commenced at 0.8 µg kg−1 min−1 and after a minimum of 1 h was decreased every 20 min in steps of 0.1 µg kg−1 min−1. Comfort scores were assessed at steady-state blood concentrations by a trained PICU nurse. Error bars show 1sd above and below the mean. Note: y-axis truncated. British Journal of Anaesthesia  , DOI: ( /bja/aem135) Copyright © 2007 British Journal of Anaesthesia Terms and Conditions

4 Fig 3 Mean steady-state arterial concentrations of remifentanil in children undergoing artificial ventilation after cardiac surgery. Remifentanil infusion commenced at 0.8 µg kg−1 min−1 and after a minimum of 1 h was decreased by 0.1 µg kg−1 min−1 every 20 min. Error bars show 1 sd above and below the mean. British Journal of Anaesthesia  , DOI: ( /bja/aem135) Copyright © 2007 British Journal of Anaesthesia Terms and Conditions

5 Fig 4 The structure of the final model showing the typical rate constants, clearances, and volume parameters for children representing the minimum, maximum, and median body weights in our study population. British Journal of Anaesthesia  , DOI: ( /bja/aem135) Copyright © 2007 British Journal of Anaesthesia Terms and Conditions

6 Fig 5 Best [(a) patient 4] and worst [(b) patient 9] model fits. The dashed line shows the population model prediction, the solid line shows the individualized model prediction and the black markers show the measured remifentanil blood concentrations. British Journal of Anaesthesia  , DOI: ( /bja/aem135) Copyright © 2007 British Journal of Anaesthesia Terms and Conditions

7 Fig 6 Plots showing the observed remifentanil blood concentrations vs the population model predicted values (a) and the individualized model predicted values (b). British Journal of Anaesthesia  , DOI: ( /bja/aem135) Copyright © 2007 British Journal of Anaesthesia Terms and Conditions

8 Fig 7 Predicted arterial blood concentrations for remifentanil using three pharmacokinetic models. Simulations of a 60-min infusion of remifentanil at 0.8 µg kg−1 min−1 were made using our model and that developed by Davis and colleagues11 and Minto and colleagues.21 British Journal of Anaesthesia  , DOI: ( /bja/aem135) Copyright © 2007 British Journal of Anaesthesia Terms and Conditions


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