The Effective Effect-Site Propofol Concentration for Induction and Intubation with Two Pharmacokinetic Models in Morbidly Obese Patients Using Total Body Weight

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dc.contributor.authorEchevarria, Ghislaine C.
dc.contributor.authorElgueta, Maria F.
dc.contributor.authorDonoso, Maria T.
dc.contributor.authorBugedo, Diego A.
dc.contributor.authorCortinez, Luis I.
dc.contributor.authorMunoz, Hernan R.
dc.date.accessioned2024-01-10T12:43:40Z
dc.date.available2024-01-10T12:43:40Z
dc.date.issued2012
dc.description.abstractBACKGROUND: Most pharmacokinetic (PK) models used for propofol administration are based on studies in normal-weight patients. Extrapolation of these models for morbidly obese patients is controversial. Using 2 PK models and a target-controlled infusion system, we determined the predicted propofol effect-site concentration (Ce) needed for induction of anesthesia in morbidly obese subjects using total body weight.
dc.description.abstractMETHODS: Sixty-six morbidly obese subjects from 18 to 50 years of age were randomized to receive propofol to reach and maintain a predetermined propofol Ce, based on the PK models of either Marsh or Schnider. All patients were monitored with a Bispectral Index electroencephalographic monitor. Fentanyl 3 mu g/kg total body weight was administered before starting the propofol infusion. After loss of consciousness, vecuronium was, administered to facilitate endotracheal intubation. Groups of 6 patients each received propofol at a different, predetermined target propofol Ce. An "effective Ce" (ECe) was defined as the propofol Ce that provided adequate hypnosis (Bispectral Index <60) during the complete induction period (45 seconds after reaching the predetermined target Ce until 5 minutes after tracheal intubation). Heart rate and arterial blood pressure were measured every 1 minute throughout the study period. Probit regression analysis was performed to calculate the effective propofol Ce values to induce hypnosis in 50% (ECe50) and 95% (ECe95) of patients with 95% confidence intervals (CIs).
dc.description.abstractRESULTS: Patient characteristics were similar between models and across the propofol target concentration groups. The ECe50 of propofol was 3.4 mu g/mL (95% CI: 2.9, 3.7 mu g/mL) with the Marsh model and 4.5 mu g/mL (95% CI: 4.1, 4.8 mu g/mL) with the Schnider model (P < 0.001). The ECe95 values were 4.2 mu g/mL (95% CI: 3.8, 6.2 mu g/mL) and 5.5 mu g/mL (95% CI: 5.0, 7.2 mu g/mL) with Marsh and Schnider models, respectively. At the ECe95, hemodynamic effects were similar with the 2 PK models.
dc.description.abstractCONCLUSION: Different propofol target concentrations for each PK model must be used for induction when using total body weight in morbidly obese patients. (Anesth Analg 2012;115: 823-9)
dc.fechaingreso.objetodigital2024-05-15
dc.format.extent7 páginas
dc.fuente.origenWOS
dc.identifier.doi10.1213/ANE.0b013e31825d6254
dc.identifier.issn0003-2999
dc.identifier.pubmedidMEDLINE:22956531
dc.identifier.urihttps://doi.org/10.1213/ANE.0b013e31825d6254
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/77613
dc.identifier.wosidWOS:000309490500012
dc.information.autorucMedicina;Cortinez L;S/I;79356
dc.information.autorucMedicina;Donoso M;S/I;182413
dc.information.autorucMedicina;Echevarria G;S/I;152736
dc.information.autorucMedicina;Elgueta M;S/I;167324
dc.information.autorucMedicina;Munoz H;S/I;73573
dc.issue.numero4
dc.language.isoen
dc.nota.accesocontenido parcial
dc.pagina.final829
dc.pagina.inicio823
dc.publisherLIPPINCOTT WILLIAMS & WILKINS
dc.revistaANESTHESIA AND ANALGESIA
dc.rightsacceso restringido
dc.subjectINFUSION
dc.subjectANESTHESIA
dc.subjectPHARMACODYNAMICS
dc.subjectCHILDREN
dc.subjectPLASMA
dc.titleThe Effective Effect-Site Propofol Concentration for Induction and Intubation with Two Pharmacokinetic Models in Morbidly Obese Patients Using Total Body Weight
dc.typeartículo
dc.volumen115
sipa.codpersvinculados79356
sipa.codpersvinculados182413
sipa.codpersvinculados152736
sipa.codpersvinculados167324
sipa.codpersvinculados73573
sipa.indexWOS
sipa.indexScopus
sipa.trazabilidadCarga SIPA;09-01-2024
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