Development of a Cost Functional for Evaluation of Remifentanil-Propofol Dosing Simulations of EsophagealInstrumentation in the Moderate Sedation Range

AbstractAn increasing number of procedures using propofol and remifentanil are performed by clinicians with no formal in anesthesiology. The rapid kinetics of these drugs can rapidly lead to adverse effects the clinician is not trained to manage. We therefore propose to investigate through simulations drug ratios and dosing regimens that allow esophageal instrumentation while minimizing the probability of adverse events. Our simulation criteria were to reach and minimize the time above the esophageal instrumentation C95 isobol, as well as minimize the time above the loss or responsiveness C99 and respiratory compromise C95 isobols. A cost functional would be developed to score each simulation. This score could be used to identify preferred solutions. Simulations were first sorted manually and then different cost functionals were developed to achieve similar results. A relatively simple equation selected 80% of the runs identified manually. Further work is needed in developing the cost functional to increase this percentage and to add meaning to the score.