| Prospective randomised comparison of Marsh and Schnider pharmacokinetic models for propofol during induction of anaesthesia in elective cardiac surgery. | |
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MedLine Citation:
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PMID: 22935955 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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CONTEXT: Haemodynamic stability during induction is a cornerstone of cardiac anaesthesia. The evaluation of pharmacokinetic models for propofol during induction is lacking. OBJECTIVE: To compare haemodynamics during cardiac anaesthesia induction with two pharmacokinetic models. DESIGN: Randomised controlled trial. SETTING: Department of Cardiothoracic Surgery, São João Hospital; July to December 2010. PATIENTS: Ninety consecutive elective adult cardiac surgical patients. INTERVENTION: Random assignment to effect-site target-controlled infusion by Marsh (n = 45) or Schnider (n = 45) pharmacokinetic models with an equilibration constant of 1.2 min adapted to Marsh's model. Invasive blood pressure measurements, propofol dose, and bispectral index (BIS) were recorded. After an initial target concentration of 1.5 μg ml, concentrations were upward-titrated in 0.5 μg ml increments until the BIS was <50. RESULTS: No differences were observed between Marsh and Schnider models in required propofol dose (0.99 ± 0.26 vs. 0.93 ± 0.31 mg kg, P = 0.322), decrease in mean blood pressure (25 ± 13 vs. 22 ± 14%, P = 0.192) or the need for vasopressors (20 vs. 24%, P = 0.800), but the use of the Marsh model resulted in a lower predicted effect-site concentration (2.3 ± 0.4 vs. 2.7 ± 0.6 μg ml, P = 0.006) and shorter time to induction (296 ± 59 vs. 338 ± 87 s, P = 0.024). There was a greater decrease in mean blood pressure in older patients (>60 years; 29 ± 10 vs. 22 ± 11%, P = 0.004) irrespective of model, but obese (BMI ≥30 kg m) and nonobese patients did not differ. MAIN OUTCOME MEASURES: Decrease in mean blood pressure. CONCLUSION: In effect-site targeting with a 1.2 min equilibration constant, Marsh's model is comparable to Schnider's during induction of anaesthesia. |
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Authors:
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João F Viterbo; André P Lourenço; Adelino F Leite-Moreira; Paulo Pinho; Fernanda Barros |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-8-29 |
Journal Detail:
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Title: European journal of anaesthesiology Volume: - ISSN: 1365-2346 ISO Abbreviation: Eur J Anaesthesiol Publication Date: 2012 Aug |
Date Detail:
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Created Date: 2012-8-31 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8411711 Medline TA: Eur J Anaesthesiol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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From the Department of Anesthesiology, Hospital São João, EPE (JFV, APL, FB); Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of the University of Porto (APL, AFL-M); Department of Cardiothoracic Surgery, Hospital São João, EPE, Porto, Portugal (AFL-M, PP). |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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