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Predictive performance of the modified Marsh and Schnider models for propofol in underweight patients undergoing general anaesthesia using target-controlled infusion

Title
Predictive performance of the modified Marsh and Schnider models for propofol in underweight patients undergoing general anaesthesia using target-controlled infusion
Authors
Lee, Y. H.Choi, G. H.Jung, K. W.Choi, B. H.Bang, J. Y.Lee, E. K.Choi, B. M.Noh, G. J.
Ewha Authors
이은경
SCOPUS Author ID
이은경scopus
Issue Date
2017
Journal Title
BRITISH JOURNAL OF ANAESTHESIA
ISSN
0007-0912JCR Link1471-6771JCR Link
Citation
vol. 118, no. 6, pp. 883 - 891
Keywords
modelpharmacokineticspropofolunderweight
Publisher
OXFORD UNIV PRESS
Indexed
SCI; SCIE; SCOPUS WOS
Abstract
Background: In our preliminary study, the modified Marsh (M-Marsh) model caused an inadvertent underdosing of propofol in underweight patients. However, the predictive performance of the M-Marsh and Schnider models incorporated in commercially available target-controlled infusion (TCI) pumps was not evaluated in underweight patients. Methods: Thirty underweight patients undergoing elective surgery were randomly allocated to receive propofol via TCI using the M-Marsh or Schnider models. The target effect-site concentrations (Ces) of propofol were, in order, 2.5, 3, 4, 5, 6 and 2 mu g ml(-1). Arterial blood samples were obtained at least 7 min after achieving each pseudo-steady-state. Results: A total of 172 plasma samples were used to determine the predictive performance of both models. The pooled median (95% confidence interval) biases and inaccuracies at a target Ce <= 3 mu g ml(-1) were -22.6 (-28.8 to -12.6) and 31.9 (24.8-36.8) for the M-Marsh model and 9.0 (1.7-16.4) and 28.5 (21.7-32.8) for the Schnider model, respectively. These values at Ce >= 4 mu g ml(-1) were -9.6 (-16.0 to -6.0) and 24.7 (21.1-27.9) for the M-Marsh model and 19.8 (12.9-25.7) and 36.2 (31.4-39.7) for the Schnider model, respectively. Conclusions: The pooled biases and inaccuracies of both models were clinically acceptable. However, the M-Marsh and Schnider models consistently produced negatively and positively biased predictions, respectively, in underweight patients. In particular, the M-Marsh model showed greater inaccuracy at target Ce <= 3 mu g ml(-1) and the Schnider model showed greater inaccuracy at target Ce >= 4 mu g ml(-1). Therefore, it is necessary to develop a new pharmacokinetic model for propofol in underweight patients.
DOI
10.1093/bja/aex102
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자연과학대학 > 통계학전공 > Journal papers
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