Department of Anesthesiology and Pain Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea.
Center for Medical Metrology, Korea Research Institute of Standards and Science (KRISS), Daejeon, Korea.
Acta Anaesthesiol Scand. 2019 Apr;63(4):448-454. doi: 10.1111/aas.13335. Epub 2019 Jan 28.
In a previous study, the modified Marsh and Schnider models respectively showed negatively- and positively-biased predictions in underweight patients. To overcome this drawback, we developed a new pharmacokinetic propofol model-the Choi model-for use in underweight patients. In the present study, we evaluated the predictive performance of the Choi model.
Twenty underweight patients undergoing elective surgery received propofol via TCI using the Choi model. The target effect-site concentrations (Ces) of propofol were 2.5, 3, 3.5, 4, 4.5, and 2 μg/mL. Arterial blood samples were obtained at least 10 minutes after achieving pseudo-steady-state. Predicted propofol concentrations with the modified Marsh, Schnider, and Eleveld pharmacokinetic models were obtained by simulation (Asan pump, version 2.1.3; Bionet Co. Ltd., Seoul, Korea). The predictive performance of each model was assessed by calculation of four parameters: inaccuracy, divergence, bias, and wobble.
A total of 119 plasma samples were used to determine the predictive performance of the Choi model. Our evaluation showed that the pooled median (95% CI) bias and inaccuracy were 4.0 (-4.2 to 12.2) and 23.9 (17.6-30.3), respectively. The pooled biases and inaccuracies of the modified Marsh, Schnider, and Eleveld models were clinically acceptable. However, the modified Marsh and Eleveld models consistently produced negatively biased predictions in underweight patients. In particular, the Schnider model showed greater inaccuracy at a target Ce ≥ 3 µg/mL.
The new propofol pharmacokinetic model (the Choi model) developed for underweight patient showed adequate performance for clinical use.
在之前的一项研究中，改良 Marsh 和 Schnider 模型分别对体重不足的患者显示出负偏和正偏预测。为了克服这一缺点，我们开发了一种新的丙泊酚药代动力学模型——Choi 模型，用于体重不足的患者。本研究旨在评估 Choi 模型的预测性能。
20 例接受择期手术的体重不足患者采用 Choi 模型接受丙泊酚 TCI。丙泊酚的目标效应部位浓度（Ce）为 2.5、3、3.5、4、4.5 和 2μg/mL。至少在达到假性稳态后 10 分钟采集动脉血样。通过模拟（Asan 泵，版本 2.1.3；Bionet 有限公司，韩国首尔）获得改良 Marsh、Schnider 和 Eleveld 药代动力学模型的预测丙泊酚浓度。通过计算四个参数来评估每个模型的预测性能：不准确性、发散度、偏差和摆动。
共使用 119 个血浆样本来确定 Choi 模型的预测性能。我们的评估结果显示，荟萃分析的中位（95%CI）偏差和不准确性分别为 4.0（-4.2 至 12.2）和 23.9（17.6-30.3）。改良 Marsh、Schnider 和 Eleveld 模型的偏倚和不准确性均在临床可接受范围内。然而，改良 Marsh 和 Eleveld 模型在体重不足的患者中始终产生负偏预测。特别是 Schnider 模型在 Ce≥3μg/mL 时显示出更大的不准确性。
为体重不足患者开发的新丙泊酚药代动力学模型（Choi 模型）具有足够的临床应用性能。
