Pharmacology of paediatric total intravenous anaesthesia
Keywords:
Anaesthesia, Pharmacokinetics, Paediatrics, Pharmacology, Propofol
Abstract
Adult parameter estimates for pharmacokinetic models over-predict plasma concentrations in children. Parameter sets that describe 3-compartment pharmacokinetic models for propofol have been published and some are now incorporated into commercially available paediatric infusion pumps. Pharmacokinetics in children is influenced by size and age. Other covariates remain poorly understood. There are no integrated pharmacokinetic-pharmacodynamic analyses available. However, methodology exists that enables us to link pharmacokinetic parameter sets with pharmacodynamic data in order to calculate a rate constant linking serum and effect site concentrations. Literature concerning paediatric total intravenous anaesthesia was reviewed to appraise these parameter sets ('models') and to outline the pharmacology behind them, their limitations and pitfalls.
References
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52. Rigby-Jones A, Sneyd JR. Cardiovascular changes after achieving constant effect site concentration of propofol. Anaesthesia. 2008;63:780.
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2. Benet LZ. A Holy Grail of clinical pharmacology: Prediction of drug pharmacokinetics and pharmacodynamics in the individual patient. Clin Pharmacol Ther. 2009;86:133-4.
3. Ma H, Lovich MA, Peterfreund RA. Quantitative analysis of continuous intravenous infusions in pediatric anesthesia: Safety implications of dead volume, flow rates, and fluid delivery. Paediatr Anaesth. 2011;21:78-86.
4. Tsao AC, Lovich MA, Parker MJ, Zheng H, Peterfreund RA. Delivery interaction between co-infused medications: An in vitro modeling study of microinfusion. Paediatr Anaesth. 2013;23:33-9.
5. McFarlan CS, Anderson BJ, Short TG. The use of propofol infusions in paediatric anaesthesia: A practical guide. Paediatr Anaesth. 1999;9:209-16.
6. Kataria BK, Ved SA, Nicodemus HF, Hoy GR, Lea D, Dubois MY, et al. The pharmacokinetics of propofol in children using three different data analysis approaches. Anesthesiology. 1994;80:104-22.
7. Hill AV. The possible effects of the aggregation of the molecules of haemoglobin on its dissociation curves. J Physiol. 1910;14:iv-vii.
8. Jeleazcov C, Ihmsen H, Schmidt J, Ammon C, Schwilden H, Schuttler J, et al. Pharmacodynamic modelling of the bispectral index response to propofol-based anaesthesia during general surgery in children. Br J Anaesth. 2008;100:509-16.
9. Roberts FL, Dixon J, Lewis GT, Tackley RM, Prys Roberts C. Induction and maintenance of propofol anaesthesia. A manual infusion scheme. Anaesthesia. 1988;43 Suppl:14-7.
10. West GB, Brown JH, Enquist BJ. The fourth dimension of life: Fractal geometry and allometric scaling of organisms. Science. 1999;284:1677-9.
11. Anderson BJ, Holford NH. Mechanism-based concepts of size and maturity in pharmacokinetics. Annu Rev Pharmacol Toxicol. 2008;48:303-32.
12. Rigby-Jones AE, Priston MJ, Sneyd JR, McCabe AP, Davis GI, Tooley MA, et al. Remifentanil-midazolam sedation for paediatric patients receiving mechanical ventilation after cardiac surgery. Br J Anaesth. 2007;99:252-61.
13. Ross AK, Davis PJ, Dear Gd GL, Ginsberg B, McGowan FX, Stiller RD, et al. Pharmacokinetics of remifentanil in anesthetized pediatric patients undergoing elective surgery or diagnostic procedures. Anesth Analg. 2001;93:1393-401.
14. Davis PJ, Wilson AS, Siewers RD, Pigula FA, Landsman IS. The effects of cardiopulmonary bypass on remifentanil kinetics in children undergoing atrial septal defect repair. Anesth Analg. 1999;89:904-8.
15. Minto CF, Schnider TW, Egan TD, Youngs E, Lemmens HJ, Gambus PL, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology. 1997;86:10-23.
16. Egan TD. Remifentanil pharmacokinetics and pharmacodynamics. A preliminary appraisal. Clin Pharmacokinet. 1995;29:80-94.
17. Welzing L, Ebenfeld S, Dlugay V, Wiesen MH, Roth B, Mueller C. Remifentanil degradation in umbilical cord blood of preterm infants. Anesthesiology. 2011;114:570-7.
18. Berde C. Convulsions associated with pediatric regional anesthesia. Anesth Analg. 1992;75:164-6.
19. Tod M, Jullien V, Pons G. Facilitation of drug evaluation in children by population methods and modelling. Clin Pharmacokinet. 2008;47:231-43.
20. Ogawa S, Okutani R, Suehiro K. Anesthetic management using total intravenous anesthesia with remifentanil in a child with osteogenesis imperfecta. J Anesth. 2009;23:123-5.
21. Marsh B, White M, Morton N, Kenny GN. Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth. 1991;67:41-8.
22. Gepts E, Camu F, Cockshott ID, Douglas EJ. Disposition of propofol administered as constant rate intravenous infusions in humans. Anesth Analg. 1987;66:1256-63.
23. Absalom A, Amutike D, Lal A, White M, Kenny GN. Accuracy of the ';Paedfusor'; in children undergoing cardiac surgery or catheterization. Br J Anaesth. 2003;91:507-13.
24. Rigby-Jones AE, Nolan JA, Priston MJ, Wright PM, Sneyd JR, Wolf AR. Pharmacokinetics of propofol infusions in critically ill neonates, infants, and children in an intensive care unit. Anesthesiology. 2002;97:1393-400.
25. Minto C, Schnider T. Expanding clinical applications of population pharmacodynamic modelling. Br J Clin Pharmacol. 1998;46:321-33.
26. Sepulveda P, Cortinez LI, Saez C, Penna A, Solari S, Guerra I, et al. Performance evaluation of paediatric propofol pharmacokinetic models in healthy young children. Br J Anaesth. 2011;107:593-600.
27. Rigouzzo A, Servin F, Constant I. Pharmacokinetic-pharmacodynamic modeling of propofol in children. Anesthesiology. 2010;113:343-52.
28. Marsh DF, Hodkinson B. Remifentanil in paediatric anaesthetic practice. Anaesthesia. 2009;64:301-8.
29. Allegaert K, de Hoon J, Verbesselt R, Naulaers G, Murat I. Maturational pharmacokinetics of single intravenous bolus of propofol. Paediatr Anaesth. 2007;17:1028-34.
30. Anderson BJ. Pediatric models for adult target-controlled infusion pumps. Paediatr Anaesth. 2010;20:223-32.
31. Allegaert K, Peeters MY, Verbesselt R, Tibboel D, Naulaers G, de Hoon JN, et al. Inter-individual variability in propofol pharmacokinetics in preterm and term neonates. Br J Anaesth. 2007;99:864-70.
32. Steur RJ, Perez RS, de Lange JJ. Dosage scheme for propofol in children under 3 years of age. Paediatr Anaesth. 2004;14:462-7.
33. Lerman J, Heard C, Steward DJ. Neonatal tracheal intubation: An imbroglio unresolved. Paediatr Anaesth. 2010;20:585-90.
34. Bennett C, Voss LJ, Barnard JP, Sleigh JW. Practical use of the raw electroencephalogram waveform during general anesthesia: The art and science. Anesth Analg. 2009;109:539-50.
35. Davidson AJ. Measuring anesthesia in children using the EEG. Pediatr Anesthesia. 2006;16:374-87.
36. Davidson AJ, Huang GH, Rebmann CS, Ellery C. Performance of entropy and Bispectral Index as measures of anaesthesia effect in children of different ages. Br J Anaesth. 2005;95:674-9.
37. Iwakiri H, Nishihara N, Nagata O, Matsukawa T, Ozaki M, Sessler DI. Individual effect-site concentrations of propofol are similar at loss of consciousness and at awakening. Anesth Analg. 2005;100:107-10.
38. McCormack J, Mehta D, Peiris K, Dumont G, Fung P, Lim J, et al. The effect of a target controlled infusion of propofol on predictability of recovery from anesthesia in children. Paediatr Anaesth. 2010;20:56-62.
39. Mani V, Morton NS. Overview of total intravenous anesthesia in children. Paediatr Anaesth. 2009;20:211-22.
40. Hume-Smith H, McCormack J, Montgomery C, Brant R, Malherbe S, Mehta D, et al. The effect of age on the dose of remifentanil for tracheal intubation in infants and children. Paediatr Anaesth. 2010;20:19-27.
41. Long LS, Ved S, Koh JL. Intraoperative opioid dosing in children with and without cerebral palsy. Paediatr Anaesth. 2009;19:513-20.
42. Valkenburg AJ, de Leeuw TG, Tibboel D, Weber F. Lower bispectral index values in children who are intellectually disabled. Anesth Analg. 2009;109:1428-33.
43. Rigouzzo A, Girault L, Louvet N, Servin F, De-Smet T, Piat V, et al. The relationship between bispectral index and propofol during target-controlled infusion anesthesia: A comparative study between children and young adults. Anesth Analg. 2008;106:1109-16.
44. Liu N, Bourgeois E, Chazot T, Murat I, Fischler M. Closed-loop administration of propofol and remifentanil guided by the Bispectral Index in patient requiring an emergency lung volume reduction. Paediatr Anaesth. 2007;17: 909-10.
45. Minto CF, Schräder TW, Gregg KM, Henthorn TK, Shafer SL. Using the time of maximum effect site concentration to combine pharmacokinetics and pharmacodynamics. Anesthesiology. 2003;99:324-33.
46. Billard V, Gambus PL, Chamoun N, Stanski DR, Shafer SL. A comparison of spectral edge, delta power, and bispectral index as EEG measures of alfentanil, propofol, and midazolam drug effect. Clin Pharmacol Ther. 1997;61:45-58.
47. Struys MM, de Smet T, Depoorter B, Versichelen LF, Mortier EP, Dumortier FJ, et al. Comparison of plasma compartment versus two methods for effect compartment-controlled target-controlled infusion for propofol. Anesthesiology. 2000;92:399-406.
48. Schnider TW, Minto CF, Shafer SL, Gambus PL, Andresen C, Goodale DB, et al. The influence of age on propofol pharmacodynamics. Anesthesiology. 1999;90:1502-16.
49. Coppens MJ, Eleveld DJ, Proost JH, Marks LA, Van Bocxlaer JF, Vereecke H, et al. An evaluation of using population pharmacokinetic models to estimate pharmacodynamic parameters for propofol and bispectral index in children. Anesthesiology. 2011;115:83-93.
50. Hahn JO, Khosravi S, Dumont GA, Ansermino JM. Two-stage vs mixed-effect approach to pharmacodynamic modeling of propofol in children using state entropy. Paediatr Anaesth. 2011;21:691-8.
51. Sneyd JR, Rigby-Jones AE. Effect site: who needs it? Br J Anaesth. 2007;98:701-4.
52. Rigby-Jones A, Sneyd JR. Cardiovascular changes after achieving constant effect site concentration of propofol. Anaesthesia. 2008;63:780.
53. Jeleazcov C, Schmidt J, Schmitz B, Becke K, Albrecht S. EEG variables as measures of arousal during propofol anaesthesia for general surgery in children: Rational selection and age dependence. Br J Anaesth. 2007;99:845-54.
54. Munoz HR, Leon PJ, Fuentes RS, Echevarría GC, Cortinez LI. Prospective evaluation of the time to peak effect of propofol to target the effect site in children. Acta Anaesthesiol Scand. 2009;53:883-90.
55. Hahn JO, Dumont GA, Ansermino JM. A direct dynamic dose-response model of propofol for individualized anesthesia care. IEEE Trans Biomed Eng. 2012;59:571-8.
56. Holford NHG, Peck CC. Population pharmacodynamics and drug development. En: Boxtel CJ, Holford NHG, Danhof M, editores. The In Vivo Study of Drug Action. New York: Elsevier Science Publishers; 1992. p. 401-14.
57. Anderson BJ. My child is unique; the pharmacokinetics are universal. Pediatr Anesth. 2012;22:530-8.
58. Han PY, Duffull SB, Kirkpatrick CM, Green B. Dosing in obesity: A simple solution to a big problem. Clin Pharmacol Ther. 2007;82:505-8.
59. Abernethy DR, Greenblatt DJ. Drug disposition in obese humans. An update. Clin Pharmacokinet. 1986;11:199-213.
60. Bouillon T, Shafer SL. Does size matter? Anesthesiology. 1998;89:557-60.
61. Green B, Duffull SB. What is the best size descriptor to use for pharmacokinetic studies in the obese? Br J Clin Pharmacol. 2004;58:119-33.
62. Casati A, Torri G. Cardiovascular stability during inhalational anaesthesia in morbidly obese patients: Which is better, sevoflurane or desflurane? Br J Anaesth. 2004;93:153-4.
63. Peters AM, Snelling HL, Glass DM, Love S, Bird NJ. Estimated lean body mass is more appropriate than body surface area for scaling glomerular filtration rate and extracellular fluid volume. Nephron Clin Pract. 2010;116:c75-80.
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How to Cite
1.
Anderson BJ. Pharmacology of paediatric total intravenous anaesthesia. Colomb. J. Anesthesiol. [Internet]. 2013 Jul. 1 [cited 2024 Apr. 26];41(3):205–214. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/693
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2013-07-01
How to Cite
1.
Anderson BJ. Pharmacology of paediatric total intravenous anaesthesia. Colomb. J. Anesthesiol. [Internet]. 2013 Jul. 1 [cited 2024 Apr. 26];41(3):205–214. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/693
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Systematic review
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