Acceptance of a propofol and remifentanil infusion dosing algorithm to optimize postoperative emergence and analgesia

  • Carl TamsEmail author
  • Ken Johnson
  • Christoph Seubert
Original Research


We implemented a pharmacokinetic/pharmacodynamic (PK/PD) based optimization algorithm recommending intraoperative Remifentanil and Propofol infusion rates to minimize time to emergence and maximize the duration of analgesia in a clinical setting. This feasibility study tested the clinical acceptance of the optimization algorithm’s recommendations during scoliosis surgical repair for 14 patients. Anesthesiologist accepted 359/394 (91%) of the recommendations given on the basis of the optimization algorithm. While following the optimization’s recommendations the anesthesiologist decreased Propofol infusions from an average of 164–135 mcg/kg/min [p = 0.002] and increased Remifentanil infusions from an average of 0.22–0.30 mcg/kg/min [p = 0.004]. The anesthesiologists appeared to accept and follow the recommendations from a PK/PD based optimization algorithm.


Anesthesia Pharmacokinetic Pharmacodynamic Total intravenous anesthesia Optimization Idiopathic scoliosis 



  1. 1.
    Gornitzky AL, Flynn JM, Muhly WT, Sankar WN. A rapid recovery pathway for adolescent idiopathic scoliosis that improves pain control and reduces time to inpatient recovery after posterior spinal fusion. Spine Deformity. 2016;4:288–95.CrossRefGoogle Scholar
  2. 2.
    Gottschalk A, Durieux M, Nemergut E. Intraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery. Anesth Analg. 2011;112:218–23.CrossRefGoogle Scholar
  3. 3.
    Nicholson A. Methadone for cancer pain. Cochrane Database Syst Rev. 2007;17: (4) CD003971.Google Scholar
  4. 4.
    Struys M, Sahinovic M, Lichtenbelt B, Vereeck H, Absalom A. Optimizing intravenous drug administration by applying pharmacokinetic/pharmacodynamic concepts. Br J Anaesth. 2011;107(1):38–47.CrossRefGoogle Scholar
  5. 5.
    Tams C, Syroid N, Johnson K. J Clin Comput Monit. 2019; 8230.Google Scholar
  6. 6.
    Pereira J, Lawlor P, Vigano A, Dorgan M, Bruera E. Equianalgesic dose ratios for opioids: a critical review and proposals for long-term dosing. J Pain Symptom Manage. 2001;22(2):672–87.CrossRefGoogle Scholar
  7. 7.
    Berdine H, Nesbit S. Equianalgesic dosing of opioids. J Pain Palliat Care Pharmacother. 2006; 20(4): 79–84.CrossRefGoogle Scholar
  8. 8.
    Minto C, Schnider T, Shafer S. Pharmacokinetics and pharmacodynamics of remifentanil II model application. Anesthesiology. 1997;86(1):24–33.CrossRefGoogle Scholar
  9. 9.
    Shafer S. All models are wrong. Anesthesiology. 2012;116(2):240–1.CrossRefGoogle Scholar
  10. 10.
    Tams C, Johnson K. Prediction variability of combined pharmacokinetic pharmacodynamic models: a simulation study of Propofol in combination with remifentanil and fentanyl. J Anesth Clin Res. 2014;5:3.CrossRefGoogle Scholar
  11. 11.
    Cirillo, et al. Navigator® and SmarPilot ® View are helpful in guiding anesthesia and reducing anesthetic drug dosing. Minerva Anesthiol. 2015;81:1163–9.Google Scholar
  12. 12.
    Kuizenga M, Hugo V, Struys M. Model-based drug administration: current status of target-controlled infusion and closed-loop control. Curr Opin Anaesthesiol. 2016;29(4):475–81.CrossRefGoogle Scholar
  13. 13.
    Chidambaran V, Costandi A, D’Mello A. Propofol: a review of its role in pediatric anesthesia and sedation. CNS Drugs. 2015;29(7):543–63.CrossRefGoogle Scholar

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© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of UtahSalt Lake CityUSA
  2. 2.Department of AnesthesiologyUniversity of FloridaGainesvilleUSA

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