Engelhardt Thomas, McCheyne Alan J, Morton Neil, Karsli Cengiz, Luginbuehl Igor, Adeli Khosrow, Walsh Warren, Bissonnette Bruno
Department of Anaesthesia, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Paediatr Anaesth. 2008 Mar;18(3):235-9. doi: 10.1111/j.1460-9592.2007.02407.x. Epub 2008 Jan 7.
A previously published pharmacokinetic simulation suggested a simple manual infusion regimen to achieve propofol plasma concentrations of 3 microg.ml(-1). This study investigated if a simple variation in propofol infusion rates is able to achieve distinct propofol plasma concentrations and whether these are close to the propofol plasma concentrations predicted by the Kataria model.
With Research Ethics Board approval and written parental consent, a total of 17 healthy children requiring general anaesthesia were enrolled. Following inhalational induction of anaesthesia, a propofol bolus of 5 mg.kg(-1) was given and anaesthesia maintained using an adaptation of the McFarlan continuous propofol infusion regimen to achieve three distinct depths of propofol anaesthesia. Weight and propofol infusion data were used to calculate simulated propofol concentrations using the Kataria dataset and the TIVA simulation program. The performance of the infusion regimen was assessed by calculating the median performance error, median absolute performance error, wobble, and divergence.
Measured propofol concentrations were (mean +/- sd) 7.15 +/- 1.4, 4.3 +/- 0.85, and 2.85 +/- 0.53 microg.ml(-1) against simulation values of 6.6, 4.1, and 2.8 microg.ml(-1), respectively, at 30, 50, and 70 min using the Kataria dataset. These differences were not significant. Formal assessment of the infusion regimen's performance was acceptable.
The manual propofol infusion regimen achieved three distinct depths of propofol anaesthesia. The manual infusion regimen produced higher plasma propofol concentrations than predicted during the early part of the infusion period but was more accurate for later time points.
先前发表的药代动力学模拟研究提出了一种简单的手动输注方案，以达到3微克·毫升⁻¹的丙泊酚血浆浓度。本研究旨在探讨丙泊酚输注速率的简单变化是否能够实现不同的丙泊酚血浆浓度，以及这些浓度是否接近Kataria模型预测的丙泊酚血浆浓度。
经研究伦理委员会批准并获得家长书面同意后，共纳入17名需要全身麻醉的健康儿童。在吸入诱导麻醉后，给予5毫克·千克⁻¹的丙泊酚 bolus，并采用改良的McFarlan丙泊酚持续输注方案维持麻醉，以达到三种不同深度的丙泊酚麻醉。利用体重和丙泊酚输注数据，通过Kataria数据集和TIVA模拟程序计算模拟的丙泊酚浓度。通过计算中位性能误差、中位绝对性能误差、摆动和离散度来评估输注方案的性能。
使用Kataria数据集，在30、50和70分钟时，测得的丙泊酚浓度（均值±标准差）分别为7.15±1.4、4.3±0.85和2.85±0.53微克·毫升⁻¹，而模拟值分别为6.6、4.1和2.8微克·毫升⁻¹。这些差异不显著。输注方案性能的正式评估是可以接受的。
手动丙泊酚输注方案实现了三种不同深度的丙泊酚麻醉。手动输注方案在输注期早期产生的血浆丙泊酚浓度高于预测值，但在后期时间点更准确。
