Pharmacokinetics and pharmacodynamics of propofol and fentanyl in patients undergoing abdominal aortic surgery - a study of pharmacodynamic drug-drug interactions
| Autor: | Agnieszka Bienert, Paweł Wiczling, Roma Hartmann-Sobczyńska, Zenon J. Kokot, Edmund Grześkowiak, Agnieszka Borsuk, Krzysztof Przybyłowski, Krzysztof Bieda, Jan Matysiak, Paweł Sobczyński |
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| Rok vydání: | 2016 |
| Předmět: |
Pharmacology
education.field_of_study medicine.drug_class business.industry Population Pharmaceutical Science General Medicine Fentanyl Hypnotic 03 medical and health sciences 0302 clinical medicine Pharmacokinetics 030202 anesthesiology Bispectral index Anesthesia Pharmacodynamics medicine Pharmacology (medical) education Propofol business 030217 neurology & neurosurgery PK/PD models medicine.drug |
| Zdroj: | Biopharmaceutics & Drug Disposition. 37:252-263 |
| ISSN: | 0142-2782 |
| DOI: | 10.1002/bdd.2009 |
| Popis: | Propofol is routinely combined with opioid analgesics to ensure adequate anesthesia during surgery. The aim of the study was to assess the effect of fentanyl on the hypnotic effect of propofol and the possible clinical implications of this interaction. The pharmacokinetic/pharmacodynamic (PK/PD) data were obtained from 11 patients undergoing abdominal aortic surgery, classified as ASA III. Propofol was administered by a target-controlled infusion system. Fentanyl 2-3 µg/kg was given whenever insufficient analgesia occurred. The bispectral index (BIS) was used to monitor the depth of anesthesia. A population PK/PD analysis with a non-linear mixed-effect model (NONMEM 7.2 software) was conducted. Two-compartment models satisfactorily described the PK of propofol and fentanyl. The delay of the anesthetic effect in relation to PK was described by the effect compartment. The BIS was linked to propofol and fentanyl effect-site concentrations through an additive Emax model. Context-sensitive decrement times (CSDT) determined from the final model were used to assess the influence of fentanyl on the recovery after anesthesia. The population PK/PD model was successfully developed to describe simultaneously the time course and variability of propofol and fentanyl concentrations and BIS. Additive propofol-fentanyl interactions were observed and quantitated. The duration of the fentanyl infusion had minimal effect on CSDT when it was shorter than the duration of the propofol infusion. If the fentanyl infusion was longer than the propofol infusion, an almost two-fold increase in CSDT occurred. Additional doses of fentanyl administered after the cessation of the propofol infusion result in lower BIS values, and can prolong the time of recovery from anesthesia. Copyright © 2016 John Wiley & Sons, Ltd. |
| Databáze: | OpenAIRE |
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