AI Article Synopsis
- The study investigates the effectiveness of existing pharmacokinetic models (Marsh and Schnider) for administering propofol during anesthesia, specifically for the newer MCT/LCT formulation as opposed to the older LCT formulation.
- Adult patients undergoing surgery were given MCT/LCT propofol, and their plasma levels were measured to assess how accurately the models predicted drug concentration during anesthesia.
- Findings show that both models performed well in predicting propofol levels, with only minor differences noted between the formulations, indicating that the existing models remain relevant for TCI of the new propofol formulation.
Article Abstract
Background: Propofol formulated with medium- and long-chain triglycerides (MCT/LCT propofol) has rapidly replaced propofol formulated with long-chain triglycerides (LCT propofol). Despite this shift, the modified Marsh and Schnider pharmacokinetic models developed using LCT propofol are still widely used for target-controlled infusion (TCI) of propofol. This study aimed to validate the external applicability of these models by evaluating their predictive performance during TCI of MCT/LCT propofol in general anesthesia.
Methods: Adult patients (n = 48) undergoing elective surgery received MCT/LCT propofol via a TCI system using either the modified Marsh or Schnider models. Blood samples were collected at various target propofol concentrations and at specific time points, including the loss of consciousness and the recovery of consciousness (13 samples per patient). The actual plasma concentration of propofol was determined using high-performance liquid chromatography. The predictive performance of each pharmacokinetic model was assessed by calculating four parameters: inaccuracy, bias, divergence, and wobble.
Results: Both the modified Marsh and Schnider models demonstrated predictive performances within clinically acceptable ranges for MCT/LCT propofol. The inaccuracy values were 24.4% for the modified Marsh model and 26.9% for the Schnider model. Both models showed an overall positive bias, 16.4% for the modified Marsh model and 16.6% for the Schnider model. The predictive performance of MCT/LCT propofol was comparable to that of LCT propofol, suggesting formulation changes might exert only a minor impact on the reliability of the TCI system during general anesthesia. Additionally, both models exhibited higher bias and inaccuracy at target concentrations ranging from 3.5 ~ 5 ug/ml than at concentrations between 2 ~ 3 ug/ml.
Conclusions: The modified Marsh and Schnider models, initially developed for LCT propofol, remain clinically acceptable for TCI with MCT/LCT propofol.
Trial Registration: This study was registered at the Clinical Research Information Service of the Korean National Institute of Health ( https://cris.nih.go.kr ; registration number: KCT0002191; 06/01/2017).
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10885499 | PMC |
| http://dx.doi.org/10.1186/s12871-024-02461-5 | DOI Listing |
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