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Malaysian Journal of Medical Sciences
School of Medical Sciences, Universiti Sains Malaysia
ISSN: 1394-195X
Vol. 25, No. 1, 2018, pp. 24-31
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Bioline Code: mj18004
Full paper language: English
Document type: Research Article
Document available free of charge
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Malaysian Journal of Medical Sciences, Vol. 25, No. 1, 2018, pp. 24-31
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Comparison of the Effects of Dexmedetomidine on the Induction of Anaesthesia Using Marsh and Schnider Pharmacokinetic Models of Propofol Target-Controlled Infusion
Wan Hassan, Wan Mohd Nazaruddin; Tan, Hai Siang & Mohamed Zaini, Rhendra Hardy
Abstract
Background: The study aimed to determine the effects of dexmedetomidine on the
induction of anaesthesia using different models (Marsh and Schnider) of propofol target-controlled
infusion (TCI).
Methods: Sixty-four patients aged 18–60 years, American Society of Anaesthesiologists
(ASA) class I-II who underwent elective surgery were randomised to a Marsh group (n = 32) or
Schnider group (n = 32). All the patients received a 1 μg/kg loading dose of dexmedetomidine,
followed by TCI anaesthesia with remifentanil at 2 ng/mL. After the effect-site concentration
(Ce) of remifentanil reached 2 ng/mL, propofol TCI induction was started. Anaesthesia induction
commenced in the Marsh group at a target plasma concentration (Cpt) of 2 μg/mL, whereas it
started in the Schnider group at a target effect-site concentration (Cet) of 2 μg/mL. If induction
was delayed after 3 min, the target concentration (Ct) was gradually increased to 0.5 μg/mL every
30 sec until successful induction. The Ct at successful induction, induction time, Ce at successful
induction and haemodynamic parameters were recorded.
Results: The Ct for successful induction in the Schnider group was significantly lower than
in the Marsh group (3.48 [0.90] versus 4.02 [0.67] μg/mL; P = 0.01). The induction time was also
shorter in the Schnider group as compared with the Marsh group (134.96 [50.91] versus 161.59
[39.64]) sec; P = 0.02). There were no significant differences in haemodynamic parameters and Ce
at successful induction.
Conclusion: In the between-group comparison, dexmedetomidine reduced the Ct
requirement for induction and shortened the induction time in the Schnider group. The inclusion
of baseline groups without dexmedetomidine in a four-arm comparison of the two models would
enhance the validity of the findings.
Keywords
Marsh; remifentanil; propofol; dexmedetomidine; target-controlled infusion; pharmacokinetic
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© Copyright 2018 - Penerbit Universiti Sains Malaysia Alternative site location: http://www.medic.usm.my/publication/mjms/
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