Kern F H, Ungerleider R M, Jacobs J R, Boyd J L, Reves J G, Goodman D, Greeley W J
Department of Anesthesiology, Duke Heart Center, Duke University Medical Center, Durham, North Carolina.
Anesth Analg. 1991 Apr;72(4):487-92. doi: 10.1213/00000539-199104000-00012.
We evaluated the efficacy of a computer-assisted continuous infusion device (CACI) using a two-drug infusion of midazolam and sufentanil as an anesthetic technique during pediatric cardiac surgery. Seventeen pediatric patients were anesthetized with CACI using age-appropriate pharmacokinetic models for administering sufentanil and midazolam. Predicted CACI plasma concentrations were correlated with assayed plasma drug concentrations at eight predefined intervals. The accuracy was assessed using median absolute prediction error. We found that plasma levels predicted by CACI provided a reasonable approximation of measured plasma concentrations for both drugs. The median absolute prediction error for sufentanil during cardiopulmonary bypass was compared with measurements made off of cardiopulmonary bypass (both pre and post cardiopulmonary bypass) and were 49% and 32%, respectively, and for midazolam 44% and 32%, respectively. We conclude that (a) current kinetic models provide a reasonable estimate of plasma drug concentrations, and (b) the ease of administration and targeted plasma level provided by the CACI system is an alternative to inhalation anesthesia using calibrated vaporizers.
我们评估了一种计算机辅助持续输注装置（CACI）的有效性，该装置在小儿心脏手术中采用咪达唑仑和舒芬太尼两药输注作为麻醉技术。17例小儿患者使用CACI麻醉，采用适合年龄的药代动力学模型来给予舒芬太尼和咪达唑仑。在八个预定义的时间间隔，预测的CACI血浆浓度与测定的血浆药物浓度相关。使用中位绝对预测误差评估准确性。我们发现，CACI预测的血浆水平为两种药物的实测血浆浓度提供了合理的近似值。将体外循环期间舒芬太尼的中位绝对预测误差与体外循环前后（体外循环前和体外循环后）的测量值进行比较，分别为49%和32%，咪达唑仑分别为44%和32%。我们得出结论：（a）当前的动力学模型能合理估计血浆药物浓度；（b）CACI系统给药简便且能达到目标血浆水平，是使用校准蒸发器进行吸入麻醉的一种替代方法。
