Cortegiani Andrea, Pavan Alessandra, Azzeri Fabio, Accurso Giuseppe, Vitale Filippo, Gregoretti Cesare
Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy.
Anestesia e Rianimazione, Ospedale Civico di Chivasso Asl TO4, Chivasso, Italy.
J Clin Pharmacol. 2018 May;58(5):606-612. doi: 10.1002/jcph.1060. Epub 2018 Jan 9.
The aim of this study was to determine the relationship, precision, and bias of a propofol target-controlled infusion (TCI) system during prolonged infusion in neurosurgical patients. We retrospectively included patients undergoing general anesthesia for elective neurosurgical removal of brain tumors and postoperative sedation in the intensive care unit over a period of 3 months. TCI of propofol (Diprifusor - Marsh model) and remifentanil were used for general anesthesia and sedation. We compared propofol blood concentration (C ) measured by liquid chromatography-mass spectroscopy with predicted concentrations (C ) by the TCI system at 40 minutes (T0), 2 hours (T1), and 4 hours (T2) and every 8 hours after starting the drug infusion and at the time of emergence from sedation. Ninety-four paired determinations of C and C from 15 adult ASA I patients (8 men and 7 women 54.9 ± 13 years old; BMI, 24 ± 3.2 kg/m ) were analyzed. Mean duration of drug administration was 31 ± 6 hours. The coefficient of determination (R ) of the linear regression model for the relationship of C and C was 0.43. At the time of emergence, C was 0.5 ± 0.18 μg/mL. The bias of the TCI system (median performance error) was -34.7%, and the precision (median absolute performance error) was 36%. Wobble and divergence were 0.3% and 12.3%, respectively. This study found bias of the system out of the range of tolerability and showed a high tendency toward overestimation. These findings may lead to undersedation when propofol TCI is used for prolonged infusion.
本研究的目的是确定丙泊酚靶控输注（TCI）系统在神经外科患者长时间输注期间的关系、精密度和偏差。我们回顾性纳入了在3个月期间接受择期神经外科脑肿瘤切除术全身麻醉及术后重症监护病房镇静的患者。丙泊酚（得普利麻 - 马什模型）和瑞芬太尼的TCI用于全身麻醉和镇静。我们在开始药物输注后40分钟（T0）、2小时（T1）和4小时（T2）以及每8小时和镇静苏醒时，将液相色谱 - 质谱法测得的丙泊酚血药浓度（C）与TCI系统预测浓度（C）进行比较。对15例成年美国麻醉医师协会（ASA）I级患者（8例男性和7例女性，年龄54.9±13岁；体重指数，24±3.2 kg/m²）的94对C和C测定值进行了分析。药物给药的平均持续时间为31±6小时。C和C关系的线性回归模型的决定系数（R²）为0.43。苏醒时，C为0.5±0.18μg/mL。TCI系统的偏差（中位性能误差）为 -34.7%，精密度（中位绝对性能误差）为36%。摆动和离散度分别为0.3%和12.3%。本研究发现该系统的偏差超出了可耐受范围，并显示出较高的高估倾向。这些发现可能导致在使用丙泊酚TCI进行长时间输注时镇静不足。
