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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
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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.

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

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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

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