Ogawa Tomoko, Obara Shinju, Akino Mitsue, Hanayama Chie, Ishido Hidemi, Murakawa Masahiro
Department of Anesthesiology, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan.
J Anesth. 2020 Jun;34(3):397-403. doi: 10.1007/s00540-020-02765-z. Epub 2020 Mar 28.
Propofol clearance can be reduced when cardiac output (CO) is decreased. This clearance reduction may alter the pharmacokinetics of propofol and worsen the predictive performance of target-controlled infusion (TCI) of propofol. The head-down position (HDP) and CO pneumoperitoneum, which are required for robotic-assisted laparoscopic prostatectomy (RALP), may cause changes in CO. We investigated the predictive performance of propofol TCI during CO pneumoperitoneum in patients who underwent RALP in the HDP.
Fifteen male patients received propofol TCI using the Diprifusor model. Propofol concentrations were measured at seven time points: (T1) 15 min after anesthesia induction; (T2) before the insufflation; (T3, T4, and T5) 15, 60, and 90 min, respectively, after insufflation in the HDP; (T6) before the release of pneumoperitoneum in the HDP; and (T7) 15 min after the release of pneumoperitoneum in the supine position. Cardiac index (CI) was assessed using an arterial pulse contour CO monitor. The predictive performance of propofol TCI was evaluated by calculating the performance errors (PE) in propofol concentrations for each data point. The relationship between CI and PE was examined. Median PE (MDPE) and median absolute PE (MDAPE) were calculated as measures of bias and accuracy, respectively.
A total of 104 blood samples were analyzed. There was significantly negative correlation between CI and PE. The predictive performance of propofol TCI during pneumoperitoneum in the HDP was acceptable (MDPE = - 1.5% and MDAPE = 18.8%).
The predictive performance of propofol TCI during RALP with CO pneumoperitoneum in the HDP was acceptable.
心输出量（CO）降低时丙泊酚清除率会下降。这种清除率降低可能会改变丙泊酚的药代动力学，并使丙泊酚靶控输注（TCI）的预测性能变差。机器人辅助腹腔镜前列腺切除术（RALP）所需的头低体位（HDP）和气腹会导致CO发生变化。我们研究了在HDP下接受RALP的患者气腹期间丙泊酚TCI的预测性能。
15例男性患者使用Diprifusor模型接受丙泊酚TCI。在七个时间点测量丙泊酚浓度：（T1）麻醉诱导后15分钟；（T2）气腹前；（T3、T4和T5）分别在HDP气腹后15、60和90分钟；（T6）HDP气腹解除前；（T7）仰卧位气腹解除后15分钟。使用动脉脉搏轮廓CO监测仪评估心脏指数（CI）。通过计算每个数据点丙泊酚浓度的性能误差（PE）来评估丙泊酚TCI的预测性能。检查CI与PE之间的关系。计算中位数PE（MDPE）和中位数绝对PE（MDAPE）分别作为偏差和准确性的指标。
共分析了104份血样。CI与PE之间存在显著负相关。HDP气腹期间丙泊酚TCI的预测性能是可以接受的（MDPE = -1.5%，MDAPE = 18.8%）。
HDP下CO气腹的RALP期间丙泊酚TCI的预测性能是可以接受的。
