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SDT, scheduled down-titration.
This was called a scheduled down-titration (SDT), and the offset of the pharmacodynamic effects of remifentanil was measured by monitoring changes in the patient's clinical status (including the level of sedation/analgesia) over time.
When propofol was administered, consumption was lower with remifentanil based sedation CLcr = creatinine clearance; HR = heart rate; ICU = intensive care unit; MAP = mean arterial pressure; PI = Pain Intensity (scale); RR = respiratory rate; SAE = serious adverse event; SAPS = Simplified Acute Physiology Score; SAS = Sedation Agitation Scale; SDT = scheduled down-titration.
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In the same type of patients, pharmacodynamic effects were studied using scheduled down-titrations at 8, 24, 48, and 72 hours of infusion [ 30].
They found that scheduled down-titrations of the remifentanil infusion at 8, 24, 48 and 72 hours resulted in statistically significant but clinically irrelevant differences in time to offset of sedative effect, as assessed on the basis of clinical signs.
The time to offset of the effects of remifentanil (at 8, 24, 48 and 72 hours during scheduled down-titrations of the infusion) were more variable and were statistically significantly longer in the moderate/severe group than in the normal/mild group at 24 hours and 72 hours.
Coping mechanisms were comprised of relationships, exercise, time management, and the ability to schedule "down time".
Titration failure was defined as failure to up-titrate more than once or as down-titration after receiving the target dose level.
One down-titration was permitted for tolerability during the first 12 weeks of the extension study.
There were no differences between bisoprolol and carvedilol with regards to the other reasons for down-titration, slowed titration, or discontinuation.
If any of the down-titrations of the initial infusion rate resulted in an alteration in MAP or HR of ± 25%, the decrements were reduced and the down-titration was performed more slowly at the investigator's discretion.
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