Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76c49bb84f-qtd2s Total loading time: 0 Render date: 2025-07-13T12:16:37.931Z Has data issue: false hasContentIssue false

Chapter 2 - You Say ‘PK’ and I Say ‘No Way!’; You Say ‘Keo’ and I Say ‘Time to Go!’

Pharmacokinetics for TIVA

Published online by Cambridge University Press:  18 November 2019

By
Frank Engbers  and
Michael G. Irwin
Edited by
Michael G. Irwin ,
Gordon T. C. Wong  and
Shuk Wan Lam
Michael G. Irwin
Affiliation:
The University of Hong Kong
Gordon T. C. Wong
Affiliation:
The University of Hong Kong
Shuk Wan Lam
Affiliation:
The University of Hong Kong
Get access

Summary

Anaesthesia is possibly the most pharmacology oriented of all clinical medical specialties. What we do every day is, effectively, applied pharmacology. Yet with all this practical experience, some aspects, particularly pharmacokinetics, can appear dauntingly complex. Indeed, mathematical modelling and developing target-controlled infusions is difficult as is the design of modern vaporisers for inhalational drugs but, as an analogy, we don’t need to be able to design a car in order to know how to drive it. However, there are certain basic PK features that will enhance your understanding and improve your ability to use these drugs appropriately.

Information

Type
Chapter
Information
Taking on TIVA
Debunking Myths and Dispelling Misunderstandings
 , pp. 5 - 13
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Csajka, C, Verotta, D.. Pharmacokinetic–pharmacodynamic modelling: history and perspectives. J Pharmacokinet Pharmacodyn 2006; 33: 227–79.CrossRefGoogle Scholar
Ausems, M.E, Vuyk, J, Hug, C.C Jr., Stanski., D.R Comparison of a computer-assisted infusion versus intermittent bolus administration of alfentanil as a supplement to nitrous oxide for lower abdominal surgery. Anesthesiology 1988; 68: 851–61.Google Scholar
Sheiner, L.B, Stanski, D.R, Vozeh, S, Miller, R.D, Ham., J Simultaneous modeling of pharmacokinetics and pharmacodynamics: application to d-tubocurarine. Clin Pharmacol Ther 1979; 25: 358–71.Google Scholar
Segre., G. Kinetics of interaction between drugs and biological systems. Farmaco Sci 1968; 23: 907–18.Google Scholar
Dahlstrom, B.E, Paalzow, L.K, Segre, G, Agren., A.J. Relation between morphine pharmacokinetics and analgesia. J Pharmacokinet Biopharm 1978; 6: 41–53.CrossRefGoogle ScholarPubMed
Scott, J.C, Ponganis, K.V, Stanski., D.R EEG quantitation of narcotic effect: the comparative pharmacodynamics of fentanyl and alfentanil. Anesthesiology 1985; 62: 234–41.CrossRefGoogle ScholarPubMed
Scott, J.C, Cooke, J.E, Stanski., D.R. Electroencephalographic quantitation of opioid effect: comparative pharmacodynamics of fentanyl and sufentanil. Anesthesiology 1991; 74: 34–42.CrossRefGoogle ScholarPubMed
White, M, Schenkels, M.J, Engbers, F.H, et al. Effect-site modelling of propofol using auditory evoked potentials. Br J Anaesth 1999; 82: 333–9.CrossRefGoogle ScholarPubMed
Masui, K, Kira, M, Kazama, T, Hagihira, S, Mortier, E.P, Struys., M.M Early phase pharmacokinetics but not pharmacodynamics are influenced by propofol infusion rate. Anesthesiology 2009; 111: 805–17.CrossRefGoogle Scholar
Minto, C.F, Schnider, T.W, Gregg, K.M, Henthorn, T.K, Shafer., S.L Using the time of maximum effect site concentration to combine pharmacokinetics and pharmacodynamics. Anesthesiology 2003; 99: 324–33.Google Scholar
Wu, Q, Sun, B, Wang, S, Zhao, L, Qi., F Estimating the plasma effect-site equilibrium rate constant (Ke(0)) of propofol by fitting time of loss and recovery of consciousness. Biol Pharm Bull 2013; 36: 1420–7.CrossRefGoogle Scholar
Engbers, F.H.M, Dahan., A Anomalies in target-controlled infusion: an analysis after 20 years of clinical use. Anaesthesia 2018; 73: 619–30.Google Scholar
Glen, J.B, Engbers., F.H The influence of target concentration, equilibration rate constant (ke0) and pharmacokinetic model on the initial propofol dose delivered in effect-site target-controlled infusion. Anaesthesia 2016; 71: 306–14.CrossRefGoogle ScholarPubMed
Doufas, A.G, Bakhshandeh, M, Bjorksten, A.R, Shafer, S.L, Sessler., D.I Induction speed is not a determinant of propofol pharmacodynamics. Anesthesiology 2004; 101: 1112–21.CrossRefGoogle Scholar
Kazama, T, Ikeda, K, Morita, K, Sanjo., Y Awakening propofol concentration with and without blood-effect site equilibration after short-term and long-term administration of propofol and fentanyl anesthesia. Anesthesiology 1998; 88: 928–34.CrossRefGoogle ScholarPubMed
Engbers., F Is unconsciousness simply the reverse of consciousness? Anaesthesia 2018; 73: 6–9.CrossRefGoogle ScholarPubMed
Seo, J.H, Goo, E.K, Song, I.A, et al. Influence of a modified propofol equilibration rate constant (k(e0)) on the effect-site concentration at loss and recovery of consciousness with the Marsh model. Anaesthesia 2013; 68: 1232–8.CrossRefGoogle ScholarPubMed
Iwakiri, H, Nishihara, N, Nagata, O, Matsukawa, T, Ozaki, M, Sessler., D.I Individual effect-site concentrations of propofol are similar at loss of consciousness and at awakening. Anesth Analg 2005; 100: 107–10.CrossRefGoogle ScholarPubMed
Olofsen, E, Romberg, R, Bijl, H, et al. Alfentanil and placebo analgesia: no sex differences detected in models of experimental pain. Anesthesiology 2005; 103: 130–9.CrossRefGoogle ScholarPubMed
Minto, C.F, Schnider, T.W, Shafer., S.L. Pharmacokinetics and pharmacodynamics of remifentanil. II. Model application. Anesthesiology 1997; 86: 24–33.Google Scholar
Jeleazcov, C, Lavielle, M, Schuttler, J, Ihmsen, H. Pharmacodynamic response modelling of arterial blood pressure in adult volunteers during propofol anaesthesia. Br J Anaesth 2015; 115: 213–26.CrossRefGoogle ScholarPubMed
Hannivoort, L.N, Eleveld, D.J, Proost, J.H, et al. Development of an optimized pharmacokinetic model of dexmedetomidine using target-controlled infusion in healthy volunteers. Anesthesiology 2015; 123: 357–67.CrossRefGoogle ScholarPubMed
Colin, P.J, Hannivoort, L.N, Eleveld, D.J, et al. Dexmedetomidine pharmacokinetic-pharmacodynamic modelling in healthy volunteers: 1. Influence of arousal on bispectral index and sedation. Br J Anaesth 2017; 119: 200–10.CrossRefGoogle ScholarPubMed
Colin, P.J, Hannivoort, L.N, Eleveld, D.J, et al. Dexmedetomidine pharmacodynamics in healthy volunteers: 2. Haemodynamic profile. Br J Anaesth 2017; 119: 211–20.CrossRefGoogle ScholarPubMed
Eleveld, D.J, Colin, P, Absalom, A.R, Struys, M. Pharmacokinetic-pharmacodynamic model for propofol for broad application in anaesthesia and sedation. Br J Anaesth 2018; 120: 942–59.CrossRefGoogle ScholarPubMed

Accessibility standard: Unknown

Accessibility compliance for the PDF of this book is currently unknown and may be updated in the future.

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×