Document Detail


Prospective randomised comparison of Marsh and Schnider pharmacokinetic models for propofol during induction of anaesthesia in elective cardiac surgery.
MedLine Citation:
PMID:  22935955     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
João F Viterbo; André P Lourenço; Adelino F Leite-Moreira; Paulo Pinho; Fernanda Barros
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-29
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  -     ISSN:  1365-2346     ISO Abbreviation:  Eur J Anaesthesiol     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
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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