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Beniwal M, Muthuchellappan R, Vazhayil V, Sharma P, Dn N, Anand Shravanthi D, Kumar HT, Philip M, Benegal V. Does Propofol Effect Site (Brain) Concentration Predicted by Target-Controlled Infusion Correlate with Propofol Measured in the Brain? An Exploratory Study in Neurosurgical Patients. World Neurosurg 2023; 179:e15-e20. [PMID: 37331472 DOI: 10.1016/j.wneu.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/11/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Total intravenous anesthesia with propofol can be administered by target-controlled infusion pumps, which work on the principles of pharmacokinetic modeling. While designing this model, neurosurgical patients were excluded as the surgical site and drug action site remained the same (brain). Whether the predicted set propofol concentration and the actual brain site concentration correlate, especially in neurosurgical patients with impaired blood-brain barrier (BBB), is still unknown. In this study we compared the set propofol effect-site concentration in the target-controlled infusion pump with actual brain concentration measured by sampling the cerebrospinal fluid (CSF). METHODS Consecutive adult neurosurgical patients requiring propofol infusion intraoperatively were recruited. Blood and CSF samples were collected simultaneously when patients received propofol infusion at 2 different target effect-site concentrations-2 and 4 ug/mL. To study BBB integrity, CSF-to-blood albumin ratio and imaging findings were compared. The propofol level in the CSF was compared with set concentration using the Wilcoxon signed-rank test. RESULTS Fifty patients were recruited, and the data were analyzed from 43 patients. There was no correlation between propofol concentration set in TCI and propofol concentration measured in blood and CSF. Though imaging findings were suggestive of BBB disruption in 37/43 patients, the mean (±standard deviation) CSF-to-serum albumin ratio was 0.0028 ± 0.002, suggesting intact BBB integrity (ratio >0.3 was considered as disrupted BBB). CONCLUSIONS CSF propofol level did not correlate with set concentration in spite of acceptable clinical anesthetic effect. Also, the CSF-to-blood albumin measurement did not provide information on the BBB integrity.
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Affiliation(s)
- Manish Beniwal
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Radhakrishnan Muthuchellappan
- Department of Neuroanaesthesia & Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Priyamvadha Sharma
- Department of Clinical Pharmacology and Toxicology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nandakumar Dn
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Daphine Anand Shravanthi
- Department of Clinical Pharmacology and Toxicology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Hemant T Kumar
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mariamma Philip
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Centre for Deaddiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Malagutti N, McGinness G, Nithyanandam DA. Real-Time Personalised Pharmacokinetic-Pharmacodynamic Modelling in Propofol Anesthesia through Bayesian Inference. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-6. [PMID: 38082840 DOI: 10.1109/embc40787.2023.10339991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Pharmacological models describe a patient's response to the administration of a medicinal drug based on parameters derived from population studies. However, considerable inter-patient variability exists, such that population models may underperform when used to predict the actual response of a specific individual. In applications which demand predictive accuracy-such as target-controlled infusion of anesthetic agents-modeling uncertainty may reduce system dependability and introduce clinical risk. Our work investigates the use of Bayesian inference, implemented through a particle filter algorithm, to refine a prior model of propofol pharmacokinetics-pharmacodynamics and estimate patient-specific parameters in real-time. We report here on an observational clinical study conducted on 40 adults undergoing general anesthesia, where we evaluated the performance of Bayesian inference-personalized models in forecasting forward trends of depth of anesthesia (Bispectral Index) measurements and compared it with that of a traditional population-based pharmacological model. Our results show a significant reduction in prediction error metrics for the patient-specific models. Our study demonstrates the viability and practical implementability of Bayesian inference as a tool for real-time intra-operative estimation of personalized pharmacological models in anesthesia applications.
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Farivar F, Jolfaei A, Manthouri M, Haghighi MS. Application of fuzzy learning in IoT-enabled remote healthcare monitoring and control of anesthetic depth during surgery. Inf Sci (N Y) 2023. [DOI: 10.1016/j.ins.2022.12.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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4
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Jung KT. Do we need to adjust the effect-site concentration of propofol in patients undergoing chemotherapy? Korean J Anesthesiol 2022; 75:109-111. [PMID: 35378573 PMCID: PMC8980287 DOI: 10.4097/kja.22098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/12/2022] Open
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5
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Zheng Z, Xue F, Wang H, He Y, Zhang L, Ma W, Zhang C, Guan Y, Ye F, Wen Y, Li X, Huang M, Huang W, Wang Z, Li J. A single nucleotide polymorphism-based formula to predict the risk of propofol TCI concentration being over 4 µg mL -1 at the time of loss of consciousness. THE PHARMACOGENOMICS JOURNAL 2022; 22:109-116. [PMID: 35064216 DOI: 10.1038/s41397-021-00263-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 11/09/2022]
Abstract
We aim to develop a formula based on single nucleotide polymorphisms (SNPs) to predict whether the propofol target-controlled infusion (TCI) concentration would be over 4 μg mL-1 at the time of loss of consciousness (LOC). We recruited 184 patients undergoing thyroid or breast surgeries with propofol anaesthesia. A total of 48 SNPs of CYP2B6, CYP2C9, UGT1A9, HNF4A, ABCB1, ABCC4, ABCG2, GABRA2, GABRA4, GABRB1, GABRB3, GABRG2, GABBR2, GAD1, SLC1A3, BDNF, and NRXN1, previously associated with propofol metabolic and pharmacology pathway, were genotyped. The formula was developed in the training cohort using the least absolute shrinkage and selection operator logistic regression model, and then validated in the testing cohort. The SNPs, GABBR2 rs1167768, GABBR2 rs1571927, NRXN1 rs601010, BDNF rs2049046, GABRA4 rs1512135, UGT1A9 rs11692021, GABBR2 rs2808536, HNF4A rs1884613, GABRB3 rs2017247, and CYP2B6 rs3181842 were selected to construct the SNP-based formula, which was used to calculate the risk score for over 4 μg mL-1 TCI concentration of propofol at the time of LOC. Patients in the high-risk group were more likely to require a propofol concentration higher than 4 μg mL-1 and presented a longer LOC latency. The SNP-based formula may significantly improve the safety and effectiveness of propofol-induced anaesthesia.
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Affiliation(s)
- Zhuoling Zheng
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China.,Department of Pharmacy, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Faling Xue
- Department of Anaesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Haini Wang
- Department of Pharmacy, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Yongqi He
- Department of Pharmacy, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lingyi Zhang
- Department of Anaesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wudi Ma
- Department of Anaesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Caibin Zhang
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanping Guan
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fang Ye
- Department of Anaesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yongzi Wen
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaoyan Li
- Department of Pharmacy, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Min Huang
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wenqi Huang
- Department of Anaesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhongxing Wang
- Department of Anaesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Jiali Li
- Institute of Clinical Pharmacology, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China. .,Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Morgan SP, Canfarotta F, Piletska EV, Grillo F, Korposh S, Liu L, Hernandez FU, Correia R, Norris A, Sinha R, Hayes-Gill BR, Piletsky SA. Optical fiber sensors for monitoring in critical care. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1139-1143. [PMID: 31946095 DOI: 10.1109/embc.2019.8856893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Monitoring of key physiological and pharmacological parameters is an important part of a closed loop control system in critical care. Optical fiber sensors provide a versatile platform technology that can be easily incorporated into existing in-dwelling catheters or face masks. With appropriate functional coatings they can be used to monitor a range of relevant parameters and two different examples are presented: (i) respiration monitoring; (ii) drug level monitoring. Respiration monitoring involves monitoring of temperature and humidity in inhaled and exhaled breath. The optical fiber sensor consists of a fiber Bragg grating to measure temperature and a tip coating whose refractive index changes with humidity. The sensor is demonstrated to be able to track breath to breath changes when incorporated into a mask. Drug level monitoring is demonstrated in vitro using a long period grating coated with molecularly imprinted polymer nanoparticles that are sensitive to fentanyl. The sensor has a limit of detection of 50ng/ml.
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7
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Guntner AS, Stöcklegger S, Kneidinger M, Illievich U, Buchberger W. Development of a highly sensitive gas chromatography-mass spectrometry method preceded by solid-phase microextraction for the analysis of propofol in low-volume cerebral microdialysate samples. J Sep Sci 2019; 42:1257-1264. [PMID: 30637930 PMCID: PMC6590146 DOI: 10.1002/jssc.201801066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/17/2019] [Accepted: 01/09/2019] [Indexed: 12/11/2022]
Abstract
To date, the commonly used intravenous anesthetic propofol has been widely studied, and fundamental pharmacodynamic and pharmacokinetic characteristics of the drug are known. However, propofol has not yet been quantified in vivo in the target organ, the human brain. Here, cerebral microdialysis offers the unique opportunity to sample propofol in the living human organism. Therefore, a highly sensitive analytical method for propofol quantitation in small sample volumes of 30 μL, based on direct immersion solid‐phase microextraction was developed. Preconcentration was followed by gas chromatographic separation and mass spectrometric detection of the compound. This optimized method provided a linear range between the lower limit of detection (50 ng/L) and 200 μg/L. Matrix‐matched calibration was used to compensate recovery issues. A precision of 2.7% relative standard deviation between five consecutive measurements and an interday precision of 6.4% relative standard deviation could be achieved. Furthermore, the permeability of propofol through a cerebral microdialysate system was tested. In summary, the developed method to analyze cerebral microdialysate samples, allows the in vivo quantitation of propofol in the living human brain. Additionally the calculation of extracellular fluid levels is enabled since the recovery of the cerebral microdialysis regarding propofol was determined.
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Affiliation(s)
| | - Simon Stöcklegger
- Department for Neuroanesthesia and Intensive Care, Kepler University Hospital Neuromed Campus, Linz, Austria
| | - Michael Kneidinger
- Department for Neuroanesthesia and Intensive Care, Kepler University Hospital Neuromed Campus, Linz, Austria
| | - Udo Illievich
- Department for Neuroanesthesia and Intensive Care, Kepler University Hospital Neuromed Campus, Linz, Austria
| | - Wolfgang Buchberger
- Institute of Analytical Chemistry, Johannes Kepler University, Linz, Austria
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González Moral ML, Selva Sevilla C, Romero Rodenas P, Tolosa Pérez MT, Lucas Pérez-Romero M, Domato Lluch M, Gerónimo Pardo M. Influence of propofol dose and blood components on duration of electrical seizures in electroconvulsive therapy. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 30143318 PMCID: PMC9391781 DOI: 10.1016/j.bjane.2018.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background and objectives Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight-adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight-adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect. Methods After approval of the Institutional Review Board, a retrospective chart review was performed of all patients who underwent at least one electroconvulsive therapy session. Multiple lineal regression analysis adjusted for potential confounders was employed to explore the effect of propofol dosage on values of bispectral index and on duration of seizure; bivariate correlation analyses were previously performed to identify variables fulfilling confounding criteria, specifically values of Spearman's rho >0.10. Results of regression analysis were expressed as B coefficient with its 95% confident interval. Results 76 patients received 631 acute phase sessions. Propofol showed a statistically significant negative effect on duration of seizure (specifically a reduction of 4.081 s for every mg.kg−1 of propofol; CI95%: −7906 to −0.255, p = 0.037) but not on bispectral index values. Slight anemia and hypoalbuminemia were very infrequent conditions, and the anticonvulsant effect was not influenced by these parameters. Conclusions Propofol weight-adjusted dose is negatively related to duration of seizures. It should be carefully titrated when employed to perform electroconvulsive therapy.
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9
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The Influence of Diabetes Mellitus on Glucuronidation and Sulphation of Paracetamol in Patients with Febrile Neutropenia. Eur J Drug Metab Pharmacokinet 2018; 44:289-294. [PMID: 30187443 PMCID: PMC6418056 DOI: 10.1007/s13318-018-0508-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Numerous studies have confirmed the influence of diabetes mellitus on the pharmacokinetics of drugs. Paracetamol (APAP) is an antipyretic that is commonly used in febrile neutropenia (FN) therapy. APAP is chiefly metabolised by glucuronidation and sulphation. This study assessed the influence of diabetes on the pharmacokinetics of paracetamol and its metabolites: glucuronide (APAP-glu) and sulfate (APAP-sulfate) in FN patients. METHODS Patients with FN received single intravenous dose 1000 mg of APAP. The FN patients were allocated to one of two groups: diabetics (DG, n = 7) or non-diabetics (NDG, n = 11). The plasma concentrations of paracetamol and its metabolites were measured with the validated high-performance liquid chromatography (HPLC) with ultraviolet (UV) detection. RESULTS Pharmacokinetic parameters (mean [SD]) of APAP in the DG and NDG groups were as follows: Cmax (maximum comcentration) = 21.50 [11.23] vs. 23.42 [9.79] mg/L, AUC0-t (area under the concentration-time curve) = 44.23 [17.93] vs. 41.43 [14.57] mg·h/L, t1/2kel (elimination half-life) = 2.28 [0.80] vs. 2.11 [0.80] h. In both groups the exposure to APAP was comparable. The study did not reveal differences between the two groups in the pharmacokinetics of APAP-glu and APAP-sulfate. The Cmax and AUC0-t ratio between the metabolites and APAP were similar. CONCLUSIONS No differences in the pharmacokinetics of APAP, APAP-glu and APAP-sulfate in patients with FN indicates that diabetes does not influence glucuronidation and sulfatation of paracetamol.
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10
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González Moral ML, Selva Sevilla C, Romero Rodenas P, Tolosa Pérez MT, Lucas Pérez-Romero M, Domato Lluch M, Gerónimo Pardo M. [Influence of propofol dose and blood components on duration of electrical seizures in electroconvulsive therapy]. Rev Bras Anestesiol 2018; 68:564-570. [PMID: 30143318 DOI: 10.1016/j.bjan.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/19/2018] [Accepted: 03/30/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight-adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight-adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect. METHODS After approval of the Institutional Review Board, a retrospective chart review was performed of all patients who underwent at least one electroconvulsive therapy session. Multiple lineal regression analysis adjusted for potential confounders was employed to explore the effect of propofol dosage on values of bispectral index and on duration of seizure; bivariate correlation analyses were previously performed to identify variables fulfilling confounding criteria, specifically values of Spearman's rho >0.10. Results of regression analysis were expressed as B coefficient with its 95% confident interval. RESULTS 76 patients received 631 acute phase sessions. Propofol showed a statistically significant negative effect on duration of seizure (specifically a reduction of 4.081s for every mg.kg-1 of propofol; CI95%: -7906 to -0.255, p=0.037) but not on bispectral index values. Slight anemia and hypoalbuminemia were very infrequent conditions, and the anticonvulsant effect was not influenced by these parameters. CONCLUSIONS Propofol weight-adjusted dose is negatively related to duration of seizures. It should be carefully titrated when employed to perform electroconvulsive therapy.
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Affiliation(s)
| | | | - Patricia Romero Rodenas
- Complejo Hospitalario Universitario de Albacete, Departamento de Salud Mental, Albacete, Espanha
| | | | - Marta Lucas Pérez-Romero
- Complejo Hospitalario Universitario de Albacete, Departamento de Salud Mental, Albacete, Espanha
| | - Mar Domato Lluch
- Complejo Hospitalario Universitario de Albacete, Departamento de Salud Mental, Albacete, Espanha
| | - Manuel Gerónimo Pardo
- Complejo Hospitalario Universitario de Albacete, Departamento de Anestesiología, Albacete, Espanha.
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Cortínez LI, Sepúlveda P, Rolle A, Cottin P, Guerrini A, Anderson BJ. Effect-Site Target-Controlled Infusion in the Obese: Model Derivation and Performance Assessment. Anesth Analg 2018; 127:865-872. [PMID: 29401079 DOI: 10.1213/ane.0000000000002814] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of this study is to derive a propofol pharmacokinetic (PK) pharmacodynamic (PD) model to perform effect-site target-controlled infusion (TCI) in obese patients, and to analyze its performance along with that of other available PK models. METHODS In the first step of the study, a 3-compartment PK model linked to a sigmoidal inhibitory Emax PD model by a first-order rate constant (keo) was used to fit propofol concentration-bispectral index (BIS) data. Population modeling analysis was performed by nonlinear mixed effects regression in NONMEM (ICON, Dublin, Ireland). PK data from 3 previous studies in obese adult patients (n = 47), including PD (BIS) data from 1 of these studies (n = 20), were pooled and simultaneously analyzed. A decrease in NONMEM objective function (ΔOBJ) of 3.84 points, for an added parameter, was considered significant at the 0.05 level. In the second step of the study, we analyzed the predictive performance (median predictive errors [MDPE] and median absolute predictive errors [MDAPE]) of the current model and of other available models using an independent data set (n = 14). RESULTS Step 1: The selected PKPD model produced an adequate fit of the data. Total body weight resulted in the best size scalar for volumes and clearances (ΔOBJ, -18.173). Empirical allometric total body weight relationships did not improve model fit (ΔOBJ, 0.309). A lag time parameter for BIS response improved the fit (ΔOBJ, 89.593). No effect of age or gender was observed. Step 2: Current model MDPE and MDAPE were 11.5% (3.7-25.0) and 26.8% (20.7-32.6) in the PK part and 0.4% (-10.39 to 3.85) and 11.9% (20.7-32.6) in the PD part. The PK model developed by Eleveld et al resulted in the lowest PK predictive errors (MDPE = <10% and MDAPE = <25%). CONCLUSIONS We derived and validated a propofol PKPD model to perform effect-site TCI in obese patients. This model, derived exclusively from obese patient's data, is not recommended for TCI in lean patients because it carries the risk of underdosing.
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Affiliation(s)
- Luis I Cortínez
- From the Department of Anaesthesiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Sepúlveda
- Servicio de Anestesia, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Augusto Rolle
- From the Department of Anaesthesiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Brian J Anderson
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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Cortegiani A, Pavan A, Azzeri F, Accurso G, Vitale F, Gregoretti C. Precision and Bias of Target‐Controlled Prolonged Propofol Infusion for General Anesthesia and Sedation in Neurosurgical Patients. J Clin Pharmacol 2018; 58:606-612. [DOI: 10.1002/jcph.1060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 11/16/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia Analgesia Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo Palermo Italy
| | - Alessandra Pavan
- Anestesia e Rianimazione Ospedale Civico di Chivasso Asl TO4 Chivasso Italy
| | | | | | - Filippo Vitale
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia Analgesia Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo Palermo Italy
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia Analgesia Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo Palermo Italy
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13
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Do Intraocular Pressure Measurements Under Anesthesia Reflect the Awake Condition? J Glaucoma 2017; 27:e28-e29. [PMID: 28984713 DOI: 10.1097/ijg.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Grundmanová M, Jarkovská D, Süß A, Tůma Z, Marková M, Grundman Z, El-Kadi A, Čedíková M, Štengl M, Kuncová J. Propofol-induced mitochondrial and contractile dysfunction of the rat ventricular myocardium. Physiol Res 2017; 65:S601-S609. [PMID: 28006942 DOI: 10.33549/physiolres.933537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Propofol is a short-acting hypnotic agent used in human medicine for sedation and general anesthesia. Its administration can be associated with serious cardiovascular side-effects that include decrease in arterial blood pressure and cardiac output. The aim of the present study was to evaluate propofol effects on mitochondrial respiration, myocardial contractility and electrophysiology in the same samples isolated from the heart ventricles of adult rats. Mitochondrial oxygen consumption was measured in permeabilized samples dissected from free walls of both ventricles using high-resolution respirometry. State LEAK was determined with malate and glutamate. Active respiration was induced by ADP (state PI) and further by succinate, a Complex II substrate (PI+II). Rotenone was injected to measure state PII. Antimycin A, a Complex III inhibitor was used to determine residual oxygen consumption (ROX). N,N,N',N'-tetramethyl-p-phenylenediamine dihydrochloride and ascorbate were injected simultaneously for respirometric assay of cytochrome c oxidase activity (CIV). Isometric contractions and membrane potentials were determined on multicellular preparations isolated from right and left ventricles. Propofol concentrations used ranged from 0.005 to 0.5 mmol/l. All respiratory parameters were significantly higher in the left control ventricles compared to the right ones. Propofol significantly decreased Complex I activity at concentration 0.025 mmol/l and papillary muscle contraction force at 0.1 mmol/l. Propofol did not affect action potential duration at any concentration studied. Our study suggests that mechanisms contributing to the impaired myocardial contraction during propofol anesthesia might include also mitochondrial dysfunction manifested by compromised activity of the respiratory Complex I.
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Affiliation(s)
- M Grundmanová
- Department of Physiology, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
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15
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Rapid Fluid Infusion and Depth of Anesthesia. Anesthesiology 2017; 126:985-986. [DOI: 10.1097/aln.0000000000001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ilyas M, Butt MFU, Bilal M, Mahmood K, Khaqan A, Ali Riaz R. A Review of Modern Control Strategies for Clinical Evaluation of Propofol Anesthesia Administration Employing Hypnosis Level Regulation. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7432310. [PMID: 28466018 PMCID: PMC5390600 DOI: 10.1155/2017/7432310] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/07/2017] [Indexed: 12/19/2022]
Abstract
Regulating the depth of hypnosis during surgery is one of the major objectives of an anesthesia infusion system. Continuous administration of Propofol infusion during surgical procedures is essential but it unduly increases the load of an anesthetist working in a multitasking scenario in the operation theatre. Manual and target controlled infusion systems are not appropriate to handle instabilities like blood pressure and heart rate changes arising due to interpatient and intrapatient variability. Patient safety, large interindividual variability, and less postoperative effects are the main factors motivating automation in anesthesia administration. The idea of automated system for Propofol infusion excites control engineers to come up with more sophisticated systems that can handle optimum delivery of anesthetic drugs during surgery and avoid postoperative effects. A linear control technique is applied initially using three compartmental pharmacokinetic and pharmacodynamic models. Later on, sliding mode control and model predicative control achieve considerable results with nonlinear sigmoid model. Chattering and uncertainties are further improved by employing adaptive fuzzy control and H∞ control. The proposed sliding mode control scheme can easily handle the nonlinearities and achieve an optimum hypnosis level as compared to linear control schemes, hence preventing mishaps such as underdosing and overdosing of anesthesia.
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Affiliation(s)
- Muhammad Ilyas
- Department of Electrical Engineering, COMSATS Institute of Information Technology, Islamabad 45550, Pakistan
- Department of Electrical Engineering, Iqra National University, Peshawar 25000, Pakistan
| | - Muhammad Fasih Uddin Butt
- Department of Electrical Engineering, COMSATS Institute of Information Technology, Islamabad 45550, Pakistan
| | - Muhammad Bilal
- Department of Electrical Engineering, COMSATS Institute of Information Technology, Islamabad 45550, Pakistan
| | - Khalid Mahmood
- Department of Electrical Engineering, Iqra National University, Peshawar 25000, Pakistan
| | - Ali Khaqan
- Department of Electrical Engineering, COMSATS Institute of Information Technology, Islamabad 45550, Pakistan
| | - Raja Ali Riaz
- Department of Electrical Engineering, COMSATS Institute of Information Technology, Islamabad 45550, Pakistan
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17
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Wang X, Zhou Q, Jiang D, Gong Y, Li E, Li H. Ion mobility spectrometry as a simple and rapid method to measure the plasma propofol concentrations for intravenous anaesthesia monitoring. Sci Rep 2016; 6:37525. [PMID: 27869199 PMCID: PMC5116632 DOI: 10.1038/srep37525] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 10/31/2016] [Indexed: 01/04/2023] Open
Abstract
The plasma propofol concentration is important information for anaesthetists to monitor and adjust the anaesthesia depth for patients during a surgery operation. In this paper, a stand-alone ion mobility spectrometer (IMS) was constructed for the rapid measurement of the plasma propofol concentrations. Without any sample pre-treatment, the plasma samples were dropped on a piece of glass microfiber paper and then introduced into the IMS cell by the thermal desorption directly. Each individual measurement could be accomplished within 1 min. For the plasma propofol concentrations from 1 to 12 μg mL-1, the IMS response was linear with a correlation coefficient R2 of 0.998, while the limit of detection was evaluated to be 0.1 μg mL-1. These measurement results did meet the clinical application requirements. Furthermore, other clinically-often-used drugs, including remifentanil, flurbiprofen and atracurium, were found no significant interference with the qualitative and quantitative analysis of the plasma propofol. The plasma propofol concentrations measured by IMS were correlated well with those measured by the high performance liquid chromatography (HPLC). The results confirmed an excellent agreement between these two methods. Finally, this method was applied to monitor the plasma propofol concentrations for a patient undergoing surgery, demonstrating its capability of anaesthesia monitoring in real clinical environments.
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Affiliation(s)
- Xin Wang
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, Liaoning, 116023, People's Republic of China
| | - Qinghua Zhou
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, Liaoning, 116023, People's Republic of China
| | - Dandan Jiang
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, Liaoning, 116023, People's Republic of China
| | - Yulei Gong
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, People's Republic of China
| | - Enyou Li
- Department of Anesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, People's Republic of China
| | - Haiyang Li
- Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, Liaoning, 116023, People's Republic of China
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18
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Smuszkiewicz P, Wiczling P, Przybyłowski K, Borsuk A, Trojanowska I, Paterska M, Matysiak J, Kokot Z, Grześkowiak E, Bienert A. The pharmacokinetics of propofol in ICU patients undergoing long-term sedation. Biopharm Drug Dispos 2016; 37:456-466. [DOI: 10.1002/bdd.2028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/08/2016] [Accepted: 08/17/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Piotr Smuszkiewicz
- Department of Anaesthesiology and Intensive Therapy; Karol Marcinkowski University of Medical Sciences; ul. Przybyszewskiego 49 60-355 Poznań Poland
| | - Paweł Wiczling
- Department of Biopharmacy and Pharmacodynamics; Medical University of Gdansk; ul. Hallera 107 80-416 Gdańsk Poland
| | - Krzysztof Przybyłowski
- Department of Clinical Pharmacy and Biopharmacy; Karol Marcinkowski University of Medical Sciences; ul. Grunwaldzka 6 60-780 Poznań Poland
| | - Agnieszka Borsuk
- Department of Biopharmacy and Pharmacodynamics; Medical University of Gdansk; ul. Hallera 107 80-416 Gdańsk Poland
| | - Iwona Trojanowska
- Department of Anaesthesiology and Intensive Therapy; Karol Marcinkowski University of Medical Sciences; ul. Przybyszewskiego 49 60-355 Poznań Poland
| | - Marta Paterska
- Department of Clinical Pharmacy and Biopharmacy; Karol Marcinkowski University of Medical Sciences; ul. Grunwaldzka 6 60-780 Poznań Poland
| | - Jan Matysiak
- Department of Inorganic and Analytical Chemistry; Karol Marcinkowski University of Medical Sciences; ul. Grunwaldzka 6 60-780 Poznań Poland
| | - Zenon Kokot
- Department of Inorganic and Analytical Chemistry; Karol Marcinkowski University of Medical Sciences; ul. Grunwaldzka 6 60-780 Poznań Poland
| | - Edmund Grześkowiak
- Department of Clinical Pharmacy and Biopharmacy; Karol Marcinkowski University of Medical Sciences; ul. Grunwaldzka 6 60-780 Poznań Poland
| | - Agnieszka Bienert
- Department of Clinical Pharmacy and Biopharmacy; Karol Marcinkowski University of Medical Sciences; ul. Grunwaldzka 6 60-780 Poznań Poland
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Influence of the Time of Intravenous Administration of Paracetamol on its Pharmacokinetics and Ocular Disposition in Rabbits. Eur J Drug Metab Pharmacokinet 2016; 42:489-498. [PMID: 27485347 DOI: 10.1007/s13318-016-0365-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Paracetamol is one of the most common analgesics and antipyretics applied in health care. The aim of the study was to investigate the influence of the time-of-day administration on the paracetamol pharmacokinetics and its penetration into aqueous humour (AH). METHODS Rabbits were divided into three groups: I-receiving paracetamol at 08.00 h, II-receiving paracetamol at 16.00 h, and III-receiving paracetamol at 24.00 h. Paracetamol was administered intravenously at a single dose of 35 mg/kg. The concentrations of paracetamol and its metabolite (paracetamol glucuronide) in the plasma, as well as in AH were measured with the validated HPLC-UV method. RESULTS No significant differences in the pharmacokinetic parameters of paracetamol was observed. When the drug was administered at 24.00 h, elimination half-life (t 1/2kel) of paracetamol glucuronide was longer than when the drug was administered 08.00 h (P = 0.0193). In addition, a statistically significant increase in the paracetamol glucuronide/paracetamol ratio was observed when the drug was administered at 08.00 vs. 16.00 h (P ≤ 0.0001) and 24.00 h (P ≤ 0.0001). CONCLUSIONS There was no chronobiological effect on the pharmacokinetic parameters of paracetamol.
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20
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Wiczling P, Bieda K, Przybyłowski K, Hartmann-Sobczyńska R, Borsuk A, Matysiak J, Kokot ZJ, Sobczyński P, Grześkowiak E, Bienert A. Pharmacokinetics and pharmacodynamics of propofol and fentanyl in patients undergoing abdominal aortic surgery - a study of pharmacodynamic drug-drug interactions. Biopharm Drug Dispos 2016; 37:252-63. [DOI: 10.1002/bdd.2009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/13/2016] [Accepted: 03/07/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Paweł Wiczling
- Department of Biopharmaceutics and Pharmacodynamics; Medical University of Gdańsk; Poland
| | - Krzysztof Bieda
- Department of Anesthesiology and Intensive Therapy; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Krzysztof Przybyłowski
- Department of Clinical Pharmacy and Biopharmacy; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Roma Hartmann-Sobczyńska
- Department of Experimental Anesthesiology; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Agnieszka Borsuk
- Department of Biopharmaceutics and Pharmacodynamics; Medical University of Gdańsk; Poland
| | - Jan Matysiak
- Department of Inorganic and Analytical Chemistry; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Zenon J. Kokot
- Department of Inorganic and Analytical Chemistry; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Paweł Sobczyński
- Department of Anesthesiology and Intensive Therapy; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Edmund Grześkowiak
- Department of Clinical Pharmacy and Biopharmacy; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Agnieszka Bienert
- Department of Clinical Pharmacy and Biopharmacy; Karol Marcinkowski University of Medical Sciences; Poznań Poland
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21
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Michel Foehn ER. Adult and pediatric anesthesia/sedation for gastrointestinal procedures outside of the operating room. Curr Opin Anaesthesiol 2016; 28:469-77. [PMID: 26087269 DOI: 10.1097/aco.0000000000000215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review presents current trends of safe and efficient anesthesia and sedation for adults and children for gastrointestinal procedures outside of the operating room with a special focus on total intravenous anesthesia (TIVA), target-controlled infusion (TCI), intravenous or topical lidocaine, and the use of the video laryngoscope. RECENT FINDINGS The concepts of a well tolerated and adequate anesthesia or sedation for gastrointestinal procedures outside of the operating room have to meet the needs of the adult and pediatric patients and the special requests of the gastroenterologists. Anesthesia and sedation of adults for gastrointestinal procedures with TIVA or TCI and spontaneous breathing is well established. Many institutions perform anesthesia for pediatric patients undergoing gastrointestinal procedures with an inhalational agent, especially in young children and for short procedures. Unlike adults, in young children the airways frequently must be secured with a tracheal tube or laryngeal mask. Respiration may be spontaneous, assisted, or controlled. TIVA and TCI are increasingly chosen for older children and longer procedures. A local anesthetic administered intravenously or topically to the upper airways and the use of the video laryngoscope can facilitate the insertion of the endoscope. SUMMARY Both anesthesiologists and nonanesthesiologists have to achieve a consensus and develop quality-improvement strategies to provide safe and efficient anesthesia and sedation for gastrointestinal procedures outside of the operating room for pediatric and adult patients. Techniques using TIVA, TCI, intravenous or topical application of lidocaine, and the video laryngoscope may improve and facilitate gastrointestinal procedures for the patients, the anesthesiologists, and the gastroenterologists.
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Affiliation(s)
- Esther R Michel Foehn
- Department of Anesthesia, Critical Care and Pain Medicine, Bethanien Hospital, Zurich, Switzerland
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22
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Vasundhar PL, Sadhasivam G, Bhushan S, Kalyan S, Chiang KC. A study on total intravenous anesthesia in orthognathic surgical procedures. Natl J Maxillofac Surg 2016; 7:127-135. [PMID: 28356683 PMCID: PMC5357933 DOI: 10.4103/0975-5950.201351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIMS AND OBJECTIVE To assess the use of propofol for induction and maintenance of anaesthesia among patients undergoing various combinations of orthognathic surgical procedures. MATERIALS AND METHODS Following Preoperative evaluation, patients were given Fentanyl (2 micrograms/kg) intravenously. Induction (2 mg/kg) and maintenance (10 mg/kg/hr) of anaesthesia was achieved by Propofol infusion. Blood Pressure and heart rate were maintained at >70 or 80 mm Hg and >50 respectively and were monitored continuously. Infusion was stopped approximately 30 to 40 minutes before the end of surgery. Immediate recovery recorded and was assessed. RESULTS The average duration of anaesthesia and surgery were found to be 4 hrs 28 min (SD= 1 hr. 35 min) and 4 hrs 3 min (SD=1 hr 38 min). None of the patients experienced pain on injection of induction agent. No significant change was observed in the mean heart rate and mean BP at different time intervals from baseline value to 30 minutes after the recovery. The average time taken to obey simple commands after stopping Propofol infusion was 42.60 ± 9.09 min. Time taken for spontaneous eye opening, full orientation and to count backwards was 43.45 ± 9.11, 47.85 ± 8.18 and 50.9 ± 9.14 respectively. Face-Hand test performed at 15 min after extubation was positive in all the patients. The mean Aldrete score at 15 min after extubation was 11.65 ± 0.75. The mean value of unaided sitting time for at least 2 min was after 119.00 ± 20.56 min. The average score of picture card test, time taken in "picking up matches" test, Ball bearing test, time taken to walk and to void urine were 5.80 ± 1.47, 67.95 ± 5.72, 9.80 ± 2.57, 172.75 ± 39.25 and 163.75 ± 55.96 respectively. Ninety percent of the patients were amenable for a repeat of this anaesthetic using the same regime but 10% of them did not answer anything. Seven patients (35%) had chills post-operatively. CONCLUSION Propofol is an excellent anaesthetic for day care procedures.
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Affiliation(s)
- P L Vasundhar
- Department of OMFS, Drs Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Vijayawada, India
| | - Gokkulakrishnan Sadhasivam
- Department of OMFS, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Dr. MGR Medical University, Guindy, Chennai, Tamil Nadu, India
| | - Satya Bhushan
- Department of OMFS, GITAM Dental College and Hospital, Visakhapatnam, India
| | - Siva Kalyan
- Department of OMFS, GITAM Dental College and Hospital, Visakhapatnam, India
| | - Kho Chai Chiang
- Department of OMFS, GITAM Dental College and Hospital, Visakhapatnam, India
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23
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Campos S, Monteiro J, Valenzuela B, Gonçalinho H, de Pinho PG, Fresco P, Félix L, Antunes L. Evidence of Different Propofol Pharmacokinetics under Short and Prolonged Infusion Times in Rabbits. Basic Clin Pharmacol Toxicol 2015; 118:421-31. [PMID: 26551921 DOI: 10.1111/bcpt.12521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/26/2015] [Indexed: 01/21/2023]
Abstract
Propofol is an anaesthetic widely used in both human beings and animals. However, the characterization of propofol pharmacokinetics (PK) is not well understood when long-term infusions are used. The main objective of this study was to explore the PK behaviour of propofol in a rabbit model during short and prolonged propofol infusions and to develop an internally validated PK model, for propofol dose individualization in the rabbit for future use. Population 1 (P1) was constituted by seven New Zealand rabbits and was used to characterize the PK profile of propofol at short infusions. Animals were anaesthetized with a bolus of 20 mg/kg, followed by an infusion rate of 50 mg/kg/hr of propofol at 1%, which was then maintained for 30 min. A second rabbit population (P2, n = 7) was sedated according to reflexes responses and Index of Consciousness values, for 20 consecutive hours using propofol 2% aiming at characterizing propofol behaviour at long-term infusions. Clinical data and blood samples were collected at specific time-points in both populations. Propofol plasma concentrations were determined by gas chromatography/ion trap mass spectrometry. The NONMEM VII software was used to evaluate the relationships between dose and plasma concentrations. A linear two-compartment model with different central compartment volume and plasma clearance (separately modelled in the two populations) was the one that best described propofol concentrations. The time course of propofol plasma concentrations was well characterized by the PK model developed, which simultaneously accounts for propofol short- and long-term infusions and can be used to optimize future PK studies in rabbits.
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Affiliation(s)
- Sónia Campos
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB) and Veterinary Sciences Department of the University of Trás-os-Montes and Alto Douro (UTAD), Portugal.,Laboratory Animal Science Institute of Molecular and Cell Biology (IBMC), Porto University, Porto, Portugal.,UCIBIO@REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Joaquim Monteiro
- IINFACTS - Instituto de Investigação e Formação Avançada em Ciências e Tecnologia da Saúde, CESPU, Paredes, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Belén Valenzuela
- Platform of Oncology, Hospital Quirón Torrevieja, Torrevieja, Alicante, Spain.,Cathedra of Multidisciplinary Oncology - UCAM, Catholic University of San Antonio, Murcia, Spain
| | - Helena Gonçalinho
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Paula Guedes de Pinho
- UCIBIO@REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Paula Fresco
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Luis Félix
- Laboratory Animal Science Institute of Molecular and Cell Biology (IBMC), Porto University, Porto, Portugal
| | - Luís Antunes
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB) and Veterinary Sciences Department of the University of Trás-os-Montes and Alto Douro (UTAD), Portugal.,Laboratory Animal Science Institute of Molecular and Cell Biology (IBMC), Porto University, Porto, Portugal
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Przybyłowski K, Tyczka J, Szczesny D, Bienert A, Wiczling P, Kut K, Plenzler E, Kaliszan R, Grześkowiak E. Pharmacokinetics and pharmacodynamics of propofol in cancer patients undergoing major lung surgery. J Pharmacokinet Pharmacodyn 2015; 42:111-22. [PMID: 25628234 PMCID: PMC4355445 DOI: 10.1007/s10928-015-9404-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/16/2015] [Indexed: 10/31/2022]
Abstract
Despite the growing number of cancer cases and cancer surgeries around the world, the pharmacokinetics (PK) and pharmacodynamics (PD) of anesthetics used in this population are poorly understood. Patients operated due to cancer are usually in severe state and often require chemotherapy. It might affect the PK/PD of drugs used in this population. Therefore, in this study we explored the PK/PD of propofol in cancer patients having a major lung surgery. 23 patients that underwent a propofol-fentanyl total intravenous anesthesia were included in the analysis. A large set of demographic, biochemical and hemodynamic parameters was collected for the purpose of covariate analysis. Nonlinear mixed effect modeling in NONMEM was used to analyze the collected data. A three-compartment model was sufficient to describe PK of propofol. The anesthetic effect (AAI index) was linked to the propofol effect site concentrations through a sigmoidal E max model. A slightly higher value of clearance, a lower value of distribution clearance, and a decreased volume of peripheral compartment were observed in our patients, as compared with the literature values reported for healthy volunteers by Schnider et al. and by Eleveld et al. Despite these differences, both models led to a clinically insignificant bias of -8 and -1 % in concentration predictions, as reflected by the median performance error. The C e50 and propofol biophase concentration at the time of postoperative orientation were low and equaled 1.40 and 1.13 mg/L. The population PK/PD model was proposed for cancer patients undergoing a major lung surgery. The large body of studied covariates did not affect PK/PD of propofol significantly. The modification of propofol dosage in the group of patients under study is not necessary when TCI-guided administration of propofol by means of the Schnider model is used.
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Affiliation(s)
- Krzysztof Przybyłowski
- Department of Clinical Pharmacy and Biopharmacy, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
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25
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Pharmacokinetics and pharmacodynamics of propofol in children undergoing different types of surgeries. Pharmacol Rep 2014; 66:821-9. [DOI: 10.1016/j.pharep.2014.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/24/2014] [Accepted: 04/28/2014] [Indexed: 11/19/2022]
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Fleckenstein J, Baeumler PI, Gurschler C, Weissenbacher T, Simang M, Annecke T, Geisenberger T, Irnich D. Acupuncture for post anaesthetic recovery and postoperative pain: study protocol for a randomised controlled trial. Trials 2014; 15:292. [PMID: 25047046 PMCID: PMC4223649 DOI: 10.1186/1745-6215-15-292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/01/2014] [Indexed: 11/30/2022] Open
Abstract
Background We report on the design and implementation of a study protocol entitled Acupuncture randomised trial for post anaesthetic recovery and postoperative pain - a pilot study (ACUARP) designed to investigate the effectiveness of acupuncture therapy performed in the perioperative period on post anaesthetic recovery and postoperative pain. Methods/Design The study is designed as a randomised controlled pilot trial with three arms and partial double blinding. We will compare (a) press needle acupuncture, (b) no treatment and (c) press plaster acupressure in a standardised anaesthetic setting. Seventy-five patients scheduled for laparoscopic surgery to the uterus or ovaries will be allocated randomly to one of the three trial arms. The total observation period will begin one day before surgery and end on the second postoperative day. Twelve press needles and press plasters are to be administered preoperatively at seven acupuncture points. The primary outcome measure will be time from extubation to ‘ready for discharge’ from the post anaesthesia care unit (in minutes). The ‘ready for discharge’ end point will be assessed using three different scores: the Aldrete score, the Post Anaesthetic Discharge Scoring System and an In-House score. Secondary outcome measures will comprise pre-, intra- and postoperative variables (which are anxiety, pain, nausea and vomiting, concomitant medication). Discussion The results of this study will provide information on whether acupuncture may improve patient post anaesthetic recovery. Comparing acupuncture with acupressure will provide insight into potential therapeutic differences between invasive and non-invasive acupuncture techniques. Trial registration NCT01816386 (First received: 28 October 2012)
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Affiliation(s)
- Johannes Fleckenstein
- Multidisciplinary Pain Centre, Department of Anaesthesiology, University of Munich, Pettenkoferstrasse 8 A, 80336 München, Germany.
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27
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Automation of anaesthesia: a review on multivariable control. J Clin Monit Comput 2014; 29:231-9. [DOI: 10.1007/s10877-014-9590-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 06/03/2014] [Indexed: 12/19/2022]
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28
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de Oliveira Junior NG, e Silva Cardoso MH, Franco OL. Snake venoms: attractive antimicrobial proteinaceous compounds for therapeutic purposes. Cell Mol Life Sci 2013; 70:4645-58. [PMID: 23657358 PMCID: PMC11113393 DOI: 10.1007/s00018-013-1345-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/10/2013] [Accepted: 04/15/2013] [Indexed: 12/27/2022]
Abstract
Gram-positive and -negative bacteria are dangerous pathogens that may cause human infection diseases, especially due to the increasingly high prevalence of antibiotic resistance, which is becoming one of the most alarming clinical problems. In the search for novel antimicrobial compounds, snake venoms represent a rich source for such compounds, which are produced by specialized glands in the snake's jawbone. Several venom compounds have been used for antimicrobial effects. Among them are phospholipases A2, which hydrolyze phospholipids and could act on bacterial cell surfaces. Moreover, metalloproteinases and L-amino acid oxidases, which represent important enzyme classes with antimicrobial properties, are investigated in this study. Finally, antimicrobial peptides from multiple classes are also found in snake venoms and will be mentioned. All these molecules have demonstrated an interesting alternative for controlling microorganisms that are resistant to conventional antibiotics, contributing in medicine due to their differential mechanisms of action and versatility. In this review, snake venom antimicrobial compounds will be focused on, including their enormous biotechnological applications for drug development.
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Affiliation(s)
- Nelson Gomes de Oliveira Junior
- Pós-Graduação em Ciências Genômicas e Biotecnologia UCB, Centro de Análises Proteômicas e Bioquímicas, Universidade Católica de Brasília, Brasília, DF Brazil
- Programa em Biologia Animal, Campus Darcy Ribeiro, Universidade de Brasília, Brasília, DF CEP 70910-900 Brazil
| | - Marlon Henrique e Silva Cardoso
- Pós-Graduação em Ciências Genômicas e Biotecnologia UCB, Centro de Análises Proteômicas e Bioquímicas, Universidade Católica de Brasília, Brasília, DF Brazil
| | - Octavio Luiz Franco
- Pós-Graduação em Ciências Genômicas e Biotecnologia UCB, Centro de Análises Proteômicas e Bioquímicas, Universidade Católica de Brasília, Brasília, DF Brazil
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del Mar Fernández de Gatta M, Martin-Suarez A, Lanao JM. Approaches for dosage individualisation in critically ill patients. Expert Opin Drug Metab Toxicol 2013; 9:1481-93. [PMID: 23898816 DOI: 10.1517/17425255.2013.822486] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Pharmacokinetic variability in critically ill patients is the result of the overlapping of multiple pathophysiological and clinical factors. Unpredictable exposure from standard dosage regimens may influence the outcome of treatment. Therefore, strategies for dosage individualisation are recommended in this setting. AREAS COVERED The authors focus on several approaches for dosage individualisation that have been developed, ranging from the well-established therapeutic drug monitoring (TDM) up to the innovative application of pharmacogenomics criteria. Furthermore, the authors summarise the specific population pharmacokinetic models for different drugs developed for critically ill patients to improve the initial dosage selection and the Bayesian forecasting of serum concentrations. The authors also consider the use of Monte Carlo simulation for the selection of dosage strategies. EXPERT OPINION Pharmacokinetic/pharmacodynamics (PK/PD) modelling and dosage individualisation methods based on mathematical and statistical criteria will contribute in improving pharmacologic treatment in critically ill patients. Moreover, substantial effort will be necessary to integrate pharmacogenomics criteria into critical care practice. The lack of availability of target biomarkers for dosage adjustment emphasizes the value of TDM which allows a large part of treatment outcome variability to be controlled.
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Affiliation(s)
- M del Mar Fernández de Gatta
- University of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy , Avda. Licenciado Méndez Núñez, 37007 Salamanca , Spain +0034 923 294 536 ; +0034 923 294 515 ;
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