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Accuracy of the 'Paedfusor' in children undergoing cardiac surgery or catheterization
1University Department of Anaesthesia, Glasgow Royal Infirmary, Queen Elizabeth Building, Alexandra Parade, Glasgow G31 2ER, UK. anthony.absalom@nnuh.nhs.uk
Insights
The Paedfusor, a new target-controlled infusion (TCI) system for children, accurately delivered propofol during anesthesia. Its performance in pediatric patients undergoing cardiac procedures was within acceptable limits for clinical use.
Area of Science:
- Anesthesiology
- Pharmacokinetics
- Pediatric Critical Care
Background:
- A prototype pediatric propofol target-controlled infusion (TCI) system, the 'Paedfusor', was developed using a pediatric-specific pharmacokinetic dataset and algorithm.
- The system is integrated into a Graseby 3500 anesthesia syringe driver.
Purpose of the Study:
- To evaluate the accuracy of the Paedfusor TCI system in pediatric patients undergoing cardiac surgery or catheterization.
- To assess the system's performance in a clinical setting with young patients.
Main Methods:
- Twenty-nine children (1-15 years) received general anesthesia with propofol via the Paedfusor system.
- Arterial blood samples were collected (up to 9 per patient) during anesthesia and recovery to measure propofol concentrations.
- Measured propofol levels were compared against concentrations predicted by the Paedfusor system.
Main Results:
- The Paedfusor system demonstrated a median performance error (MDPE) of 4.1% and a median absolute performance error (MDAPE) of 9.7%.
- The median wobble was 8.3%, indicating good performance.
- These results were significantly better than those reported for the adult 'Diprifusor' system.
Conclusions:
- The Paedfusor system's performance was found to be within acceptable limits for its use as a TCI system in pediatric patients.
- The study supports the clinical utility of the Paedfusor for precise propofol administration in children.
Background:
A prototype paediatric propofol target-controlled infusion (TCI) system, the 'Paedfusor' has been developed. This system incorporates a paediatric pharmacokinetic data set and algorithm specific for children in a Graseby 3500 anaesthesia syringe driver. In this study we have evaluated the accuracy of the Paedfusor TCI system in children who underwent either cardiac surgery or cardiac catheterization procedures.
Methods:
Twenty-nine children aged 1-15 yr were investigated. General anaesthesia was provided using propofol administered by the Paedfusor system. Accuracy of the system was evaluated by obtaining up to 9 arterial samples for measurement of propofol concentration both during anaesthesia and in the recovery period. Measured arterial propofol concentrations were then compared with values calculated by the Paedfusor.
Results:
The predictive indices of median performance error (MDPE), and median absolute performance error (MDAPE) of the Paedfusor system were found to be 4.1% and 9.7%, respectively and the median value for wobble was 8.3%. These values are much better than those found with the adult 'Diprifusor' system.
Conclusion:
The Paedfusor performance was found to be within the accepted limits for use as a TCI system.
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