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KMID : 0356920130650040299
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Korean Journal of Anesthesiology
2013 Volume.65 No. 4 p.299 ~ p.305
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The comparison of predictive performance in bispectral index prediction during target effect-site controlled infusion of propofol using different blood effect-site equilibration rate constants in the same pharmacokinetic model
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Choi Byung-Moon
Bang Ji-Youn
Jung Kyeo-Woon
Lee Ju-Hyun
Bae Heon-Yong
Noh Gyu-Jeong
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Abstract
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Background: Blood-brain equilibration rate constant (ke0) is derived from either pharmacokinetic and pharmacodynamic modeling (ke0_model) or a model-independent observed time to peak effect (ke0_tpeak). Performance in bispectral index (BIS) prediction was compared between ke0_model and ke0_tpeak for microemulsion or long chain triglyceride (LCT) propofol.
Methods: Time to peak effect (tpeak, time to a maximally reduced BIS value) of microemulsion propofol after an intravenous bolus (1 mg/kg) was measured in 100 patients (group Amicro). An observed tpeak of 1.6 min for LCT propofol was obtained from an earlier study. Another 40 patients received a target controlled infusions of microemulsion propofol (ke0_model = 0.187/min, group Bmicro = 20) or LCT propofol (ke0_model = 0.26/min, group BLCT = 20) and remifentanil. The ke0_tpeak’s in group Bmicro and BLCT were calculated using the observed tpeak value obtained from group Amicro and 1.6 min, respectively. Effect-site concentrations of propofol were recalculated using the amounts of propofol infused over time and ke0_tpeak’s. Predicted BIS values calculated by sigmoid Emax equations with ke0_model and ke0_tpeak were compared with observed BIS values during induction and emergence for both formulations of propofol.
Results: Observed tpeak of microemulsion propofol was 1.68 min. The median performance errors of BIS in group Bmicro were -1.83% (-24.8 to 18.9, ke0_model) and -2.42% (-26.1 to 36.2, ke0_tpeak), while 8.01% (-20.5 to 30.1, ke0_model) and 7.37% (-27.0 to 49.1, ke0_tpeak) in group BLCT. The median absolute performance errors of BIS in group Bmicro were 11.87% (2.2-31.1ke0_model) and 14.38% (-0.6 to 44.6, ke0_tpeak), while 17.31% (5.54-36.0, ke0_model) and 18.28% (-0.1 to 56.0, ke0_tpeak) in group BLCT.
Conclusions: The ke0_model showed better performance in BIS prediction than the ke0_tpeak.
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KEYWORD
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Bispectral index, Pharmacokinetic, Propofol
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