脊柱侧弯手术期间儿童丙泊酚血药浓度的实测值与预测值

Measured versus predicted blood propofol concentrations in children during scoliosis surgery.

作者信息

Panchatsharam Selvakumar, Callaghan Michael, Day Rachel, Sury Michael R J

机构信息

From the *Portex Department of Anesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom, and †Institute of Child Health, University College London, London, United Kingdom.

出版信息

Anesth Analg. 2014 Nov;119(5):1150-7. doi: 10.1213/ANE.0000000000000413.

DOI:10.1213/ANE.0000000000000413

PMID:25225889

Abstract

BACKGROUND

Propofol anesthesia is preferred during scoliosis surgery because it suppresses evoked potential spinal cord function less than other drugs and better enables the detection of spinal cord ischemia. In this study, we determined the difference between the true and predicted blood propofol levels during target-controlled infusions in children during scoliosis surgery.

METHODS

Arterial blood propofol measured concentrations (Cm) were compared with predicted concentrations (Cp) approximately every 30 minutes during the maintenance phase of anesthesia in 20 children. Whole blood propofol concentrations were measured using a point-of-care blood propofol analyzer. Anesthesia management was not affected by the study. The median performance error, median absolute performance error, wobble, and divergence were calculated.

RESULTS

Children were aged 9 to 17 years and weighed 26.5 to 95 kg. The Paedfusor model was used in 16 children and the Marsh model in 4 children. In 154 blood propofol measurements, the mean difference between the Cm and Cp was 1.5 µg·mL (limits of agreement, -1.4 to 4.5 µg·mL), and the mean performance error was 44.7% (limits of agreement, -40.1% to 130.2%). The median performance error and median absolute performance error for the whole group were 39.8% (range, -20.9% to 103.3%) and 39.8% (range, 20%-103.3%), respectively. The performance errors improved with increase in duration of infusion (divergence, -2.2 [range, -1.03 to 0.13]). Cm was almost always larger than Cp except in 2 children who had consistently lower Cm than Cp (lowest Cm(s) were 1.74 and 1.96 µg·mL when the Cp was 3 µg·mL); both had the Paedfusor model and their body weights were 28 and 33 kg.

CONCLUSIONS

Propofol target-controlled infusion models had poor performance characteristics in children undergoing scoliosis surgery. Point-of-care propofol assay may enable adjustment of the infusion to better achieve the intended blood level.

摘要

背景

在脊柱侧弯手术中，丙泊酚麻醉是首选，因为与其他药物相比，它对诱发电位脊髓功能的抑制作用较小，并且能更好地检测脊髓缺血。在本研究中，我们确定了脊柱侧弯手术患儿靶控输注期间丙泊酚实际血药浓度与预测血药浓度之间的差异。

方法

在20名儿童麻醉维持阶段，大约每30分钟比较一次动脉血丙泊酚测量浓度（Cm）与预测浓度（Cp）。使用即时检测丙泊酚分析仪测量全血丙泊酚浓度。麻醉管理不受本研究影响。计算中位性能误差、中位绝对性能误差、摆动度和离散度。

结果

儿童年龄为9至17岁，体重为26.5至95千克。16名儿童使用Paedfusor模型，4名儿童使用Marsh模型。在154次丙泊酚血药浓度测量中，Cm与Cp的平均差值为1.5μg·mL（一致性界限为-1.4至4.5μg·mL）,平均性能误差为44.7%（一致性界限为-40.1%至130.2%）。全组的中位性能误差和中位绝对性能误差分别为39.8%（范围为-20.9%至103.3%）和39.8%（范围为20%至103.3%）。随着输注时间的延长，性能误差有所改善（离散度为-2.2[范围为-1.03至0.13]）。除2名儿童的Cm持续低于Cp外（当Cp为3μg·mL时，最低Cm分别为1.74和1.96μg·mL），Cm几乎总是高于Cp；这两名儿童均使用Paedfusor模型，体重分别为28千克和33千克。