Potential pitfalls of propofol target controlled infusion delivery related to its pharmacokinetics and pharmacodynamics

Target controlled infusion (TCI) devices are increasingly used in clinical practice. These devices unquestionably aid optimization of drug dosage. However, it still remains to be determined if they sufficiently address differences in pharmacological make up of individual patients. The algorithms guiding TCI pumps are based on pharmacological data obtained from a relatively small number of healthy volunteers, which are then extrapolated, on the basis of sophisticated pharmacokinetic and pharmacodynamic modeling, to predict plasma concentrations of the drug and its effect on general population. One has to realize the limitation of this approach: these models may be less accurate when applied to patients in extreme clinical conditions: in intensive care units, with a considerable loss of blood, severe hypothermia or temporary changes in the composition of plasma, e.g., hypoalbuminemia. In the future, data obtained under these "extreme" clinical circumstances, may be used to modify the dosage algorithms of propofol TCI systems to match the clinical scenario.

[1]  Harald Ihmsen.  Population Pharmacokinetics of Propofol , 2000 .

[2]  A. Dawidowicz,et al.  Influence of propofol concentration in human plasma on free fraction of the drug. , 2006, Chemico-biological interactions.

[3]  E. García-Martín,et al.  Polymorphic drug metabolism in anaesthesia. , 2009, Current drug metabolism.

[4]  B. Lacarelle,et al.  Pharmacokinetics of long-term propofol infusion used for sedation in ICU patients. , 1990, Anesthesiology.

[5]  J. Vuyk.  Pharmacodynamics in the elderly. , 2003, Best practice & research. Clinical anaesthesiology.

[6]  'In vitro' binding of propofol to serum lipoproteins in thyroid dysfunction , 2002, European Journal of Clinical Pharmacology.

[7]  K. Patel,et al.  Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol , 2003, Paediatric anaesthesia.

[8]  G. Orliaguet,et al.  [Propofol infusion syndrome]. , 2010, Annales francaises d'anesthesie et de reanimation.

[9]  Michel Struys,et al.  Pharmacokinetics in obese patients , 2004 .

[10]  G. Snyder,et al.  Effect of anaesthetic technique and other perioperative factors on cancer recurrence. , 2010, British journal of anaesthesia.

[11]  Donald Bucher,et al.  Propofol infusion syndrome: a rare complication with potentially fatal results. , 2008, Critical care nurse.

[12]  R. Kaliszan,et al.  Pharmacokinetics and pharmacodynamics of propofol in patients undergoing abdominal aortic surgery , 2012, Pharmacological reports : PR.

[13]  R. Farinotti,et al.  Propofol Infusion for Maintenance of Anesthesia in Morbidly Obese Patients Receiving Nitrous Oxide A Clinical and Pharmacokinetic Study , 1993, Anesthesiology.

[14]  B. Chi,et al.  Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia , 2009, BMC health services research.

[15]  J Schüttler,et al.  Population Pharmacokinetics of Propofol: A Multicenter Study , 2000, Anesthesiology.

[16]  S L Shafer,et al.  Pharmacokinetics and Pharmacodynamics of Propofol Infusions during General Anesthesia , 1988, Anesthesiology.

[17]  J. DeJongh,et al.  Disease Severity Is a Major Determinant for the Pharmacodynamics of Propofol in Critically Ill Patients , 2008, Clinical pharmacology and therapeutics.

[18]  Jinbao Li,et al.  Anesthesia awareness and the bispectral index. , 2008, The New England journal of medicine.

[19]  M. Struys,et al.  Influence of obesity on propofol pharmacokinetics: derivation of a pharmacokinetic model. , 2010, British journal of anaesthesia.

[20]  G. Kenny,et al.  'Paedfusor' pharmacokinetic data set. , 2005, British journal of anaesthesia.

[21]  P. Steen,et al.  Bispectral index, predicted and measured drug levels of target‐controlled infusions of remifentanil and propofol during laparoscopic cholecystectomy and emergence , 2000, Acta anaesthesiologica Scandinavica.

[22]  Isabelle Murat,et al.  Maturational pharmacokinetics of single intravenous bolus administration of propofol during childhood: 9AP5-1 , 2007 .

[23]  K. Morita,et al.  Do the kidneys contribute to propofol elimination? , 2008, British journal of anaesthesia.

[24]  S. Shafer,et al.  The Influence of Method of Administration and Covariates on the Pharmacokinetics of Propofol in Adult Volunteers , 1998, Anesthesiology.

[25]  Fumio Goto,et al.  Changes in Drug Plasma Concentrations of an Extensively Bound and Highly Extracted Drug, Propofol, in Response to Altered Plasma Binding , 2004, Clinical pharmacology and therapeutics.

[26]  I. Constant,et al.  Which model for propofol TCI in children , 2010, Paediatric anaesthesia.

[27]  J. Schüttler,et al.  Pharmacokinetics and pharmacodynamics of propofol/alfentanil infusions for sedation in ICU patients , 1995, Intensive Care Medicine.

[28]  M. Avram,et al.  What determines anesthetic induction dose? It's the front-end kinetics, doctor! , 1999, Anesthesia and analgesia.

[29]  T. Short,et al.  The use of propofol infusions in paediatric anaesthesia: a practical guide , 1999, Paediatric anaesthesia.

[30]  Jeffrey C. Sigl,et al.  Anesthetic Management and One-Year Mortality After Noncardiac Surgery , 2005, Anesthesia and analgesia.

[31]  M. Todd,et al.  Practice Advisory for Intraoperative Awareness and Brain Function Monitoring: A Report by the American Society of Anesthesiologists Task Force on Intraoperative Awareness , 2006, Anesthesiology.

[32]  R N Upton,et al.  Cardiac output is a determinant of the initial concentrations of propofol after short-infusion administration. , 1999, Anesthesia and analgesia.

[33]  J. Brichant.  [The Helsinki Declaration on Patient Safety in Anaesthesiology]. , 2010, Acta anaesthesiologica Belgica.

[34]  P. Pévet,et al.  Reciprocal Relationships between General (Propofol) Anesthesia and Circadian Time in Rats , 2007, Neuropsychopharmacology.

[35]  M. White,et al.  Accuracy of the 'Paedfusor' in children undergoing cardiac surgery or catheterization. , 2003, British journal of anaesthesia.

[36]  J. Crooks,et al.  Pharmacokinetics in the Elderly , 1976, Clinical pharmacokinetics.

[37]  P. Glass,et al.  Pharmacokinetics in the elderly. , 2003, Best practice & research. Clinical anaesthesiology.

[38]  J. Bruhn,et al.  Depth of anaesthesia monitoring: what's available, what's validated and what's next? , 2006, British journal of anaesthesia.

[39]  K. Borowicz,et al.  Melatonin in experimental seizures and epilepsy , 2011, Pharmacological reports : PR.

[40]  C. Minto,et al.  Contributions of PK/PD Modeling to Intravenous Anesthesia , 2008, Clinical pharmacology and therapeutics.

[41]  P. Wiczling,et al.  Influence of Time of Day on Propofol Pharmacokinetics and Pharmacodynamics in Rabbits , 2011, Chronobiology international.

[42]  Mats O. Karlsson,et al.  A two-compartment effect site model describes the bispectral index after different rates of propofol infusion , 2010, Journal of Pharmacokinetics and Pharmacodynamics.

[43]  C. Reilly,et al.  Evaluation of the predictive performance of a ‘Diprifusor’ TCI system , 1998, Anaesthesia.

[44]  K. Kusza,et al.  Influence of demographic factors, basic blood test parameters and opioid type on propofol pharmacokinetics and pharmacodynamics in ASA I–III patients , 2011, Arzneimittelforschung.

[45]  Thomas V Perneger,et al.  The Swiss cheese model of safety incidents: are there holes in the metaphor? , 2005, BMC health services research.

[46]  C. Saint-Maurice,et al.  Pharmacokinetics of propofol in young children after a single dose. , 1989, British journal of anaesthesia.

[47]  Steven Edward Kern,et al.  The Influence of Hemorrhagic Shock on Propofol: A Pharmacokinetic and Pharmacodynamic Analysis , 2003, Anesthesiology.

[48]  J. Gross,et al.  Textbook of Intravenous Anesthesia , 1997 .

[49]  P. Kam,et al.  Propofol infusion syndrome , 2007, Anaesthesia.

[50]  M. Struys,et al.  Pharmacokinetic models for propofol--defining and illuminating the devil in the detail. , 2009, British journal of anaesthesia.

[51]  C. Perry,et al.  Propofol: a review of its use in intensive care sedation of adults. , 2003, CNS drugs.

[52]  N. Morton,et al.  Pharmacokinetic model driven infusion of propofol in children. , 1991, British journal of anaesthesia.

[53]  S L Shafer,et al.  The influence of age on propofol pharmacodynamics. , 1999, Anesthesiology.

[54]  P. Boon,et al.  Influence of Hypovolemia on the Pharmacokinetics and the Electroencephalographic Effect of Propofol in the Rat , 2000, Anesthesiology.

[55]  E. Olofsen,et al.  Mixed-effects Modeling of the Influence of Alfentanil on Propofol Pharmacokinetics , 2004, Anesthesiology.

[56]  G. Orliaguet,et al.  Le syndrome de perfusion du propofol , 2010 .

[57]  I. Murat,et al.  Pharmacokinetics of Propofol after a Single Dose in Children Aged 1–3 Years with Minor Burns: Comparison of Three Data Analysis Approaches , 1996, Anesthesiology.

[58]  Björn Lemmer,et al.  Disturbance of Circadian Rhythms in Analgosedated Intensive Care Unit Patients with and without Craniocerebral Injury , 2007, Chronobiology international.

[59]  N. Morton,et al.  Overview of total intravenous anesthesia in children , 2010, Paediatric anaesthesia.

[60]  C. Royse.  Is depth of anesthesia, as assessed by the bispectral index, related to postoperative cognitive dysfunction and recovery? , 2007, Anesthesia and analgesia.

[61]  G T Lewis,et al.  Induction and maintenance of propofol anaesthesia , 1988, Anaesthesia.

[62]  P. Steen,et al.  Bispectral index, serum drug concentrations and emergence associated with individually adjusted target-controlled infusions of remifentanil and propofol for laparoscopic surgery. , 2003, British journal of anaesthesia.

[63]  Y. Nakata,et al.  Emergence Agitation After Sevoflurane Versus Propofol in Pediatric Patients , 2000 .

[64]  Kotaro Kaneda,et al.  Population pharmacokinetics of a propofol bolus administered in patients with major burns. , 2010, Burns : journal of the International Society for Burn Injuries.

[65]  J. DeJongh,et al.  Population pharmacokinetic and pharmacodynamic modeling of propofol for long‐term sedation in critically ill patients: A comparison between propofol 6% and propofol 1% , 2002, Clinical pharmacology and therapeutics.

[66]  I. Constant,et al.  Pharmacokinetic-Pharmacodynamic Modeling of Propofol in Children , 2010, Anesthesiology.

[67]  K. Kusza,et al.  Assessing circadian rhythms in propofol PK and PD during prolonged infusion in ICU patients , 2010, Journal of Pharmacokinetics and Pharmacodynamics.

[68]  D. Tibboel,et al.  Pilot study on the influence of liver blood flow and cardiac output on the clearance of propofol in critically ill patients , 2008, European Journal of Clinical Pharmacology.

[69]  J. Swanson.  Pharmacokinetics / Pharmacodynamics , 2011 .

[70]  H F Nicodemus,et al.  The Pharmacokinetics of Propofol in Children Using Three Different Data Analysis Approaches , 1994, Anesthesiology.