Propofol Breath Monitoring as a Potential Tool to Improve the Prediction of Intraoperative Plasma Concentrations
| Autor: | Johannes P van den Berg, Michel Struys, Cyrill Hornuss, Douglas J. Eleveld, Gustav Schelling, Christian C. Apfel, Pieter Colin, Hugo Vereecke |
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| Přispěvatelé: | Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE) |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Models Biological 01 natural sciences Inhalation Anesthetics Intraoperative Period Young Adult 03 medical and health sciences PHARMACOKINETIC MODEL 0302 clinical medicine Pharmacokinetics 030202 anesthesiology medicine Humans Pharmacology (medical) EXPOSURE Intensive care medicine Propofol Monitoring Physiologic Pharmacology business.industry 010401 analytical chemistry INFUSION Intravenous Anesthetics Exhalation Bayes Theorem 0104 chemical sciences Bayesian Forecast CHLOROFORM Anesthesia Plasma concentration Drug dosing Female business Anesthetics Intravenous medicine.drug |
| Zdroj: | Clinical Pharmacokinetics, 55(7), 849-859. Springer International Publishing AG |
| ISSN: | 1179-1926 0312-5963 |
| Popis: | Introduction Monitoring of drug concentrations in breathing gas is routinely being used to individualize drug dosing for the inhalation anesthetics. For intravenous anesthetics however, no decisive evidence in favor of breath concentration monitoring has been presented up until now. At the same time, questions remain with respect to the performance of currently used plasma pharmacokinetic models implemented in target-controlled infusion systems. In this study, we investigate whether breath monitoring of propofol could improve the predictive performance of currently applied, target-controlled infusion models.Methods Based on data from a healthy volunteer study, we developed an addition to the current state-of-the-art pharmacokinetic model for propofol, to accommodate breath concentration measurements. The potential of using this pharmacokinetic (PK) model in a Bayesian forecasting setting was studied using a simulation study. Finally, by introducing bispectral index monitor (BIS) measurements and the accompanying BIS models into our PK model, we investigated the relationship between BIS and predicted breath concentrations.Results and Discussion We show that the current state-of-the-art pharmacokinetic model is easily extended to reliably describe propofol kinetics in exhaled breath. Furthermore, we show that the predictive performance of the a priori model is improved by Bayesian adaptation based on the measured breath concentrations, thereby allowing further treatment individualization and a more stringent control on the targeted plasma concentrations during general anesthesia. Finally, we demonstrated concordance between currently advocated BIS models, relying on predicted effect-site concentrations, and our new approach in which BIS measurements are derived from predicted breath concentrations. |
| Databáze: | OpenAIRE |
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