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A pharmacokinetic-pharmacodynamic real-time display may change anesthesiologists' behavior.
Obara, Shinju; Syroid, Noah; Ogura, Takahiro; Pace, Nathan L; Johnson, Ken B; Albert, Rob; Agutter, Jim; Stuart, Ami R; Egan, Talmage D.
Afiliação
  • Obara S; Department of Anesthesiology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 9601295, Japan.
  • Syroid N; Department of Anesthesiology, University of Utah, UT, 30 N 1900 E, RM 3C444, Salt Lake City, 84132, USA.
  • Ogura T; Department of Anesthesiology, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 1548532, Japan.
  • Pace NL; Department of Anesthesiology, University of Utah, UT, 30 N 1900 E, RM 3C444, Salt Lake City, 84132, USA.
  • Johnson KB; Department of Anesthesiology, University of Utah, UT, 30 N 1900 E, RM 3C444, Salt Lake City, 84132, USA.
  • Albert R; Department of Anesthesiology, University of Utah, UT, 30 N 1900 E, RM 3C444, Salt Lake City, 84132, USA.
  • Agutter J; College of Architecture and Planning, University of Utah, UT, 375 S 1530 E, Suite 235, Salt Lake City, 84112, USA.
  • Stuart AR; Department of Anesthesiology, University of Utah, UT, 30 N 1900 E, RM 3C444, Salt Lake City, 84132, USA. ami.stuart@hsc.utah.edu.
  • Egan TD; Department of Anesthesiology, University of Utah, UT, 30 N 1900 E, RM 3C444, Salt Lake City, 84132, USA.
J Clin Monit Comput ; 35(3): 547-556, 2021 05.
Article em En | MEDLINE | ID: mdl-32356076
ABSTRACT
We have developed a real-time graphical display that presents anesthetic pharmacology data (drug effect site concentrations (Ce) and probability of anesthetic effects including hypnosis, loss of response to tracheal intubation), improving a previous prototype. We hypothesized that the use of the display alters (1) clinical behavior of anesthesiologists (i.e., Ce of isoflurane and fentanyl at the end of anesthesia), (2) fentanyl dose during the first 30 min of recovery in the post anesthesia care unit (PACU), and that the response of clinicians to the display in terms of workload and utility is favorable. The display was evaluated in a two-group, non-randomized prospective observational study of 30 patients undergoing general anesthesia using isoflurane and fentanyl. The isoflurane-predicted Ce was lower in the display group (without-display 0.64% ± 0.06%; with-display 0.42 ± 0.04%; t23.9 = 3.17, P = 0.004 < adjusted alpha 0.05/2). The difference in fentanyl-predicted Ce did not achieve statistical significance (without-display 1.5 ± 0.1 ng/ml; with-display 2.0 ± 0.2 ng/ml; t25.5 = 2.26, P = 0.03 > adjusted alpha 0.05/2) (means ± standard error). A joint test of isoflurane and fentanyl Ce with respect to the display condition rejected the null hypothesis of no differences (Hotelling T2, P = 0.01), supporting our primary hypothesis. The total fentanyl per patient during the first 30 min in the PACU with the display was 75.0 ± 62.7 µg and that without the display was 83.0 ± 74.7 µg. There was no significant difference between the groups (means ± standard deviation, P = 0.75). There were no differences in perceived workload. Use of the display does not appear to be cognitively burdensome and may change the anesthesiologist's dosing regimen.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Anestesiologistas / Isoflurano Tipo de estudo: Clinical_trials / Observational_studies Limite: Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Anestesiologistas / Isoflurano Tipo de estudo: Clinical_trials / Observational_studies Limite: Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article