Pj. Bowen et al., THE INTERACTION OF ELTANOLONE AND FENTANYL WITH SPECIAL REFERENCE TO LOGISTIC-REGRESSION ANALYSIS, Anesthesia and analgesia, 87(4), 1998, pp. 967-972
We investigated whether fentanyl decreases the serum concentrations of
the steroid anesthetic eltanolone effective in producing loss of cons
ciousness in 50% of patients (EC50induction) and in preventing movemen
t at skin incision in 50% of patients (EC50induction). For anesthetic
induction, patients received effect-site target concentrations of fent
anyl 0.0, 1.5, 3.0, or 4.5 ng/mL and eltanolone 500, 750, 1000, or 120
0 ng/mL. Loss of response to verbal command was assessed after 10 min.
For incision, patients received effect-site target concentrations of
fentanyl 0.5, 1.5, 3.0, or 4.5 ng/mL and eltanolone 547-2926 ng/mL. Mo
vement at incision was assessed at least 10 min after new targets were
entered. Probability of loss of consciousness and of movement versus
arterial serum concentration combinations were analyzed by logistic re
gression. Dixon up-down analysis was used to estimate ET50incision eff
ective target concentration combinations. In the absence of fentanyl,
anesthesia was induced in only I of 12 patients, which suggests that t
he EC50induction is >1500 ng/mL at fentanyl 0.0 ng/mL. With fentanyl (
38 patients), eltanolone EC50induction was independent of fentanyl con
centration, calculated as 628 ng/mL. For the incision phase (52 patien
ts), logistic regression failed to generate a valid model. Dixon analy
sis (43 patients) produced an eltanolone ET50incision of 2288 ng/mL at
fentanyl targets of 0.5 ng/mL, 754 ng/mL at 1.5 ng/mL, 735 ng/mL at 3
.0 ng/mL, and 645 ng/mL at 4.5 ng/mL. Fentanyl reduced the serum conce
ntration of eltanolone required to produce loss of consciousness and t
he target concentration of eltanolone required to prevent movement to
skin incision. Implications: Fentanyl reduced the serum concentration
of eltanolone required to produce loss of consciousness and the target
concentration of eltanolone required to prevent movement to skin inci
sion. Future interaction studies of this nature using logistic regress
ion should model responses to hypnotic alone separately from responses
to hypnotic-analgesic combinations.