Response Surface Modeling of Remimazolam and Sevoflurane
Response Surface Model Between Remimazolam and Sevoflurane; Comparison of the Minto and the Greco Model
This prospective randomized open-label study aims to investigate the pharmacodynamic interaction between remimazolam and sevoflurane during general anesthesia using response surface modeling. Although remimazolam has favorable hemodynamic stability compared with propofol, its hypnotic effect may be less predictable and poorly correlated with conventional sedation monitoring indices such as the bispectral index (BIS). In clinical practice, remimazolam and sevoflurane are often combined during induction and maintenance of anesthesia; however, the optimal interaction between these agents remains unclear.
This study will evaluate whether the interaction between remimazolam and sevoflurane is synergistic, additive, or infra-additive using two representative response surface interaction models: the Minto model and the Greco model. BIS values and predicted effect-site concentrations will be analyzed using NONMEM software.
Tutkimuksen yleiskatsaus
Tila
Interventio / Hoito
Yksityiskohtainen kuvaus
Remimazolam is a recently developed ultra-short-acting benzodiazepine anesthetic with favorable pharmacokinetic characteristics, including a short context-sensitive decrement time and relatively stable hemodynamics. Despite these advantages, remimazolam may exhibit weaker hypnotic potency and inconsistent correlations with conventional anesthetic depth monitors such as BIS.
In current clinical practice, anesthesiologists frequently combine remimazolam with volatile anesthetics such as sevoflurane during induction or maintenance of anesthesia. However, the pharmacodynamic interaction between remimazolam and sevoflurane has not been fully elucidated.
The present study will investigate the interaction between remimazolam and sevoflurane using response surface modeling. The study will enroll adult patients undergoing elective laparoscopic surgery under general anesthesia. Various combinations of remimazolam infusion rates and end-tidal sevoflurane concentrations will be administered during anesthetic induction. BIS values and predicted effect-site concentrations will be collected and analyzed.
Pharmacodynamic interaction analyses will be performed using NONMEM nonlinear mixed-effects modeling software. Both the Minto interaction model and the Greco interaction model will be applied to determine whether the interaction between remimazolam and sevoflurane is synergistic, additive, or infra-additive.
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Vaihe
- Ei sovellettavissa
Yhteystiedot ja paikat
Opiskeluyhteys
- Nimi: Hee Young Kim, MD, PhD
- Puhelinnumero: 82-55-360-2129
- Sähköposti: anekhy@gmail.com
Opiskelupaikat
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Yangsan, Etelä -Korea, 50612
- Rekrytointi
- Pusan National University Yangsan Hospital
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Ottaa yhteyttä:
- Hee Young Kim, MD, PhD
- Puhelinnumero: 82-55-360-2129
- Sähköposti: anekhy@gmail.com
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Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
- Aikuinen
- Vanhempi Aikuinen
Hyväksyy terveitä vapaaehtoisia
Kuvaus
Inclusion Criteria:
- Adults aged 20 to 80 years
- Scheduled for elective surgery under general anesthesia at Pusan National University Yangsan Hospital
- American Society of Anesthesiologists (ASA) physical status I or II
- Able to provide written informed consent
Exclusion Criteria:
- Known allergy to remimazolam or sevoflurane
- Renal, hepatic, neuromuscular, or neurological disease
- Use of medications affecting the central nervous system
- Chronic psychoactive drug use
- Ischemic heart disease
- Pregnant women
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Perustiede
- Jako: Ei käytössä
- Inventiomalli: Yksittäinen ryhmätehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
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Kokeellinen: Remimazolam and Sevoflurane Combination During Anesthetic Induction
Participants undergoing elective surgery under general anesthesia will receive varying combinations of remimazolam and sevoflurane during anesthetic induction to evaluate pharmacodynamic interactions using response surface modeling.
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Remimazolam will be administered at infusion rates ranging from 0 to 6 mg/kg/h using an infusion pump with pharmacokinetic simulation software.
Sevoflurane will be administered by inhalation with targeted end-tidal concentrations between 0 and 2 vol%.
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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
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Interaction coefficient (α) between remimazolam and sevoflurane derived from the Minto response surface model
Aikaikkuna: During anesthetic induction
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The interaction coefficient (α) describing the pharmacodynamic interaction between remimazolam effect-site concentration and end-tidal sevoflurane concentration will be estimated using the Minto response surface model based on BIS values collected during anesthetic induction.
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During anesthetic induction
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Interaction parameter between remimazolam and sevoflurane derived from the Greco response surface model
Aikaikkuna: During anesthetic induction
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The pharmacodynamic interaction parameter describing the interaction between remimazolam effect-site concentration and end-tidal sevoflurane concentration will be estimated using the Greco response surface model based on BIS values collected during anesthetic induction.
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During anesthetic induction
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Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
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BIS response according to hypnotic combinations
Aikaikkuna: During anesthetic induction
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Bispectral Index (BIS) values will be continuously recorded during anesthetic induction according to predefined combinations of remimazolam effect-site concentration and end-tidal sevoflurane concentration.
The BIS is a processed electroencephalographic monitoring scale ranging from 0 to 100, where lower values indicate deeper levels of hypnosis and higher values indicate lighter levels of sedation or consciousness.
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During anesthetic induction
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Loss of consciousness (LOC)
Aikaikkuna: During anesthetic induction
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Time to loss of consciousness during induction
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During anesthetic induction
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Recovery of consciousness (ROC)
Aikaikkuna: During emergence from anesthesia
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Time to recovery of consciousness
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During emergence from anesthesia
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Heart rate
Aikaikkuna: Intraoperative period
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Heart rate (beats per minute) will be recorded at 5-minute intervals during the intraoperative period.
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Intraoperative period
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Systolic blood pressure
Aikaikkuna: Intraoperative period
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Systolic blood pressure (mmHg) will be recorded at 5-minute intervals during the intraoperative period.
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Intraoperative period
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Mean blood pressure
Aikaikkuna: Intraoperative period
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Mean blood pressure (mmHg) will be recorded at 5-minute intervals during the intraoperative period.
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Intraoperative period
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Cardiac output
Aikaikkuna: Intraoperative period
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Cardiac output (L/min) will be recorded at 5-minute intervals during the intraoperative period.
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Intraoperative period
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Cardiac index
Aikaikkuna: Intraoperative period
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Cardiac index (L/min/m²) will be recorded at 5-minute intervals during the intraoperative period.
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Intraoperative period
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Stroke volume variation
Aikaikkuna: Intraoperative period
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Stroke volume variation (%) will be recorded at 5-minute intervals during the intraoperative period.
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Intraoperative period
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Pulse pressure variation
Aikaikkuna: Intraoperative period
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Pulse pressure variation (%) will be recorded at 5-minute intervals during the intraoperative period.
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Intraoperative period
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Peripheral oxygen saturation
Aikaikkuna: Intraoperative period
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Peripheral oxygen saturation (%) will be recorded at 5-minute intervals during the intraoperative period.
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Intraoperative period
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Yhteistyökumppanit ja tutkijat
Tutkijat
- Päätutkija: Hee Young Kim, MD, PhD, Pusan National University Yangsan Hospital, Yangsan, South Korea
Julkaisuja ja hyödyllisiä linkkejä
Yleiset julkaisut
- Choe S, Choi BM, Lee YH, Lee SH, Lee EK, Kim KS, Noh GJ. Response surface modelling of the pharmacodynamic interaction between propofol and remifentanil in patients undergoing anaesthesia. Clin Exp Pharmacol Physiol. 2017 Jan;44(1):30-40. doi: 10.1111/1440-1681.12677.
- Jeon S, Kwon JY, Kim HK, Kim TK. Synergism between rocuronium and cisatracurium: comparison of the Minto and Greco interaction models. Korean J Anesthesiol. 2016 Aug;69(4):341-9. doi: 10.4097/kjae.2016.69.4.341. Epub 2016 Jun 22.
- Byung-Moon Choi: An overview of pharmacodynamic drug interaction with isobole and response surface model in anesthesia. APM 2016; 11: 1-13
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Todellinen)
Ensisijainen valmistuminen (Arvioitu)
Opintojen valmistuminen (Arvioitu)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
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