Interaction Between Nitrous Oxide, Sevoflurane, and Opioids: A Response Surface Approach

Vereecke, Hugo E M; Proost, Johannes H; Heyse, Bjorn; Eleveld, Douglas J; Katoh, Takasumi; Luginbühl, Martin; Struys, Michel M R F (2013). Interaction Between Nitrous Oxide, Sevoflurane, and Opioids: A Response Surface Approach. Anesthesiology, 118(4), pp. 894-902. Hagerstown, Md.: Lippincott Williams & Wilkins 10.1097/ALN.0b013e3182860486

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BACKGROUND:: The interaction of sevoflurane and opioids can be described by response surface modeling using the hierarchical model. We expanded this for combined administration of sevoflurane, opioids, and 66 vol.% nitrous oxide (N2O), using historical data on the motor and hemodynamic responsiveness to incision, the minimal alveolar concentration, and minimal alveolar concentration to block autonomic reflexes to nociceptive stimuli, respectively. METHODS:: Four potential actions of 66 vol.% N2O were postulated: (1) N2O is equivalent to A ng/ml of fentanyl (additive); (2) N2O reduces C50 of fentanyl by factor B; (3) N2O is equivalent to X vol.% of sevoflurane (additive); (4) N2O reduces C50 of sevoflurane by factor Y. These four actions, and all combinations, were fitted on the data using NONMEM (version VI, Icon Development Solutions, Ellicott City, MD), assuming identical interaction parameters (A, B, X, Y) for movement and sympathetic responses. RESULTS:: Sixty-six volume percentage nitrous oxide evokes an additive effect corresponding to 0.27 ng/ml fentanyl (A) with an additive effect corresponding to 0.54 vol.% sevoflurane (X). Parameters B and Y did not improve the fit. CONCLUSION:: The effect of nitrous oxide can be incorporated into the hierarchical interaction model with a simple extension. The model can be used to predict the probability of movement and sympathetic responses during sevoflurane anesthesia taking into account interactions with opioids and 66 vol.% N2O.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
UniBE Contributor:	Luginbühl, Martin
ISSN:	0003-3022
Publisher:	Lippincott Williams & Wilkins
Language:	English
Submitter:	Jeannie Wurz
Date Deposited:	04 Oct 2013 14:33
Last Modified:	05 Dec 2022 14:10
Publisher DOI:	10.1097/ALN.0b013e3182860486
PubMed ID:	23360899
Web of Science ID:	000316355000019
URI:	https://boris.unibe.ch/id/eprint/13008 (FactScience: 219509)