A pharmacodynamic analysis of factors affecting recovery from anesthesia with propofol-remifentanil target controlled infusion

作者：Koo Bon nyeo; Lee Jeong rim; Noh Gyu jeong; Lee Jae hoon; Kang Young ran; Han Dong woo^*

来源：Acta Pharmacologica Sinica, 2012, 33(8): 1080-1084.

DOI：10.1038/aps.2012.85

• anesthesia
• effect-site concentration
• propofol
• pharmacodynamic modeling
• return of consciousness
• target-controlled infusion

Aim: To examine individual patient%26apos;s demographic parameters and clinical variables related to return of consciousness (ROC) and the pharmacodynamic relationship between propofol effect-site concentration (C-e) and ROC from propofol-remifentanil anesthesia. %26lt;br%26gt;Methods: Ninety-four patients received propofol-remifentanil anesthesia using the effect-site target-controlled infusion (TCI) system. All clinical events were noted, and variables possibly related to propofol C-e at ROC were examined using linear correlation analyses. Pharmacodynamic modeling incorporating covariates was performed using NONMEM (Nonlinear Mixed Effects Modeling) VII software. %26lt;br%26gt;Results: The C-e values of propofol at loss of consciousness (LOC) and ROC were 4.4 +/- 1.1 mu g/mL and 1.1 +/- 0.3 mu g/mL, respectively. Age was negatively correlated with propofol C-e at ROC (r=-0.48, P%26lt;0.01). Including age as a covariate in C-e50 (the effect-site concentration associated with 50% probability of return of consciousness) and. (the steepness of the concentration-versus-response relationship) significantly improved the performance of the basic model based on the likelihood ratio test, with a significant decrease in the minimum value of the objective function. The C-e50 in 25-, 50-, and 75-year-old patients was predicted to be 1.38, 1.06, and 0.74 mu g/mL, respectively. The lambda in 25-, 50-, and 75-year-old patients was predicted to be 12.23, 8.70, and 5.18, respectively. %26lt;br%26gt;Conclusion: Age significantly affects the relationship between propofol C-e and ROC, and pharmacodynamic modeling including age could lead to better predictions of ROC during emergence from propofol-remifentanil anesthesia.

• 出版日期2012-8