Department of Anaesthesia, Chiba Children's Hospital, Heta-cho 579-1, Midori-ku, Chiba, Chiba, 266-0007, Japan.
Department of Anaesthesiology, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama 359-8513, Japan.
Br J Anaesth. 2017 Mar 1;118(3):415-423. doi: 10.1093/bja/aex007.
Predictive performance of eleven published propofol pharmacokinetic models was evaluated for long-duration propofol infusion in children.
Twenty-one aged three-11 yr ASA I-II patients were included. Anaesthesia was induced with propofol or sevoflurane, and maintained with propofol, remifentanil, and fentanyl. Propofol was continuously infused at rates of 4-14 mg kg - 1 h - 1 after an initial bolus of 1.5-2.0 mg kg - 1 . Venous blood samples were obtained every 30-60 min for five h and then every 60-120 min after five h from the start of propofol administration, and immediately after the end of propofol administration. Model performance was assessed with prediction error (PE) derivatives including divergence PE, median PE (MDPE), and median absolute PE (MDAPE) as time-related PE shift, measures for bias, and inaccuracy, respectively.
We collected 85 samples over 270 (130) (88-545), mean (SD) (range), min. The Short model for children, and the Schüttler general-purpose model had acceptable performance (-20%≤MDPE ≤ 20%, MDAPE ≤ 30%, -4% h - 1 ≤ divergence PE ≤ 4% h - 1 ). The Short model showed the best performance with the maximum predictive performance metric. Two models developed only using bolus dosing (Shangguan and Saint-Maurice models) and the Paedfusor of the remaining nine models had significant negative divergence PE (≤-6.1% h - 1 ).
The Short model performed well during continuous infusion up to 545 min. This model might be preferable for target-controlled infusion for long-duration anaesthesia in children.
评估了 11 种已发表的丙泊酚药代动力学模型在儿童长时间丙泊酚输注中的预测性能。
纳入 21 名 ASA I-II 级 3-11 岁的患者。麻醉诱导采用丙泊酚或七氟醚，维持采用丙泊酚、瑞芬太尼和芬太尼。丙泊酚初始剂量为 1.5-2.0mg/kg，然后以 4-14mg/kg·h -1 的速度持续输注。静脉血样在丙泊酚给药后每 30-60min 采集一次，前 5h 每 60-120min 采集一次，然后在给药结束后立即采集。通过预测误差（PE）衍生物评估模型性能，包括发散性 PE、中位数 PE（MDPE）和中位数绝对 PE（MDAPE），分别作为时间相关的 PE 偏移、偏差和不准确性的度量。
我们共采集了 85 个样本，时间为 270（130）（88-545）min，均值（SD）（范围），min。儿童专用的 Short 模型和 Schüttler 通用模型表现出可接受的性能（-20%≤MDPE≤20%，MDAPE≤30%，-4% h -1 ≤发散性 PE≤4% h -1 ）。Short 模型的预测性能指标最大，表现出最佳性能。仅使用负荷剂量开发的两个模型（Shangguan 和 Saint-Maurice 模型）和其余 9 个模型中的 Paedfusor 模型的发散性 PE 显著为负（≤-6.1% h -1 ）。
Short 模型在持续输注长达 545min 时表现良好。该模型可能更适合儿童长时间麻醉的靶控输注。
