Maitre Model (based on 45 pts) or Scott Model (based on 12 pts) both 3 compartment models
Maitre assumes a larger central compartment and a greater clearance than Scott
- Both Maitre and Scott models under predict plasma concentrations during infusion
- Maitre model under predicts plasma concentrations after infusion stopped
- Whereas Scott Model over predicts plasma concentrations
So Maitre model will:
- Infuse more drug for given target compared with the Scott model
- And predicted a faster decrement when the infusion is stopped
Dial up effector site conc. of 100ng/ml, then reduce to 60ng/ml after 5mins
Titrate up and down 10ng/ml based on usual parameters (e.g. HR and BP)
Stop infusion 10-20mins before end of surgery
(NB: after 4hr infusion context sensitive half-time is 60mins!)
Use Remifentanil as more haemodynamic stability and less response to laryngoscopy. And it wears off in 10 minutes, irrespective of infusion rate or duration!!
It might be worth trying out alfentanil TCI before remifentanil is completely out of stock!
(And then cancelling the rest of the list while you wait for the patient to start breathing!)