Yonsei Med J.  2014 Nov;55(6):1624-1630. 10.3349/ymj.2014.55.6.1624.

Modeling of Recovery Profiles in Mentally Disabled and Intact Patients after Sevoflurane Anesthesia; A Pharmacodynamic Analysis

• Shin TJ
• Noh GJ
• Koo YS
• Han DW

• KMID: 2070212
• DOI: http://doi.org/10.3349/ymj.2014.55.6.1624

Abstract

PURPOSE
Mentally disabled patients show different recovery profiles compared to normal patients after general anesthesia. However, the relationship of dose-recovery profiles of mentally disabled patients has never been compared to that of normal patients.
MATERIALS AND METHODS
Twenty patients (10 mentally disabled patients and 10 mentally intact patients) scheduled to dental surgery under general anesthesia was recruited. Sevoflurane was administered to maintain anesthesia during dental treatment. At the end of the surgery, sevoflurane was discontinued. End-tidal sevoflurane and recovery of consciousness (ROC) were recorded after sevoflurane discontinuation. The pharmacodynamic relation between the probability of ROC and end-tidal sevoflurane concentration was analyzed using NONMEM software (version VII).
RESULTS
End-tidal sevoflurane concentration associated with 50% probability of ROC (C50) and gamma value were lower in the mentally disabled patients (C50=0.37 vol %, gamma=16.5 in mentally intact patients, C50=0.19 vol %, gamma=4.58 in mentally disabled patients). Mentality was a significant covariate of C50 for ROC and gamma value to pharmacodynamic model.
CONCLUSION
A sigmoid Emanx model explains the pharmacodynamic relationship between end-tidal sevoflurane concentration and ROC. Mentally disabled patients may recover slower from anesthesia at lower sevoflurane concentration at ROC an compared to normal patients.

Keyword

Anesthesia; general; mentally disabled persons; sevoflurane

MeSH Terms

*Anesthesia Recovery Period
Anesthesia, Dental/*methods
Anesthesia, General/*methods
Anesthetics, Inhalation/*administration & dosage/pharmacology
Case-Control Studies
Child
Child, Preschool
Consciousness/drug effects
Dental Care for Disabled/*methods
Dose-Response Relationship, Drug
Female
Humans
Male
Mentally Disabled Persons
Methyl Ethers/*administration & dosage/pharmacology
Anesthetics, Inhalation
Methyl Ethers

Figure

• 

  Fig. 1 The relationship between end-tidal sevoflurane concentration and probability of return of consciousness. The red scattered lines indicate individual fits for mentally disabled patients. The black solid lines indicate individual fits for mentally intact patients. The red thick scattered line denotes the representative of fit for mentally disabled patient. The black thick solid line denotes the representative of fit for mentally intact patient. Etsevo, end-tidal sevoflurane concentration; ROC, recovery of consciousness.

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