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Related Experiment Videos

Target controlled infusions: targeting the effect site while limiting peak plasma concentration.

Guido E Van Poucke1, Louis J Brandon Bravo, Steven L Shafer

  • 1Ziekenhuis Zeeuws-Vlaanderen, Terneuzen 4532 JB, the Netherlands. guido.vanpoucke@pandora.be

IEEE Transactions on Bio-Medical Engineering
|November 13, 2004
PubMed
Summary

A new algorithm for target-controlled infusion (TCI) systems reduces peak plasma concentrations by 60%, minimizing side effects with only a modest 20% delay in anesthetic drug effect onset.

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Area of Science:

  • Anesthesiology
  • Pharmacokinetics
  • Mathematical Modeling

Background:

  • Target-controlled infusion (TCI) systems are widely available globally, excluding North America.
  • Current TCI systems target plasma drug concentration, which may not correlate with the actual site of drug effect.
  • Existing algorithms aiming for the effect site can lead to elevated plasma concentrations, potentially increasing acute hemodynamic side effects of anesthetic drugs.

Purpose of the Study:

  • To introduce a novel mathematical algorithm for TCI devices that controls the effect site concentration.
  • To investigate the algorithm's ability to limit peak plasma concentrations and mitigate associated side effects.
  • To evaluate the impact of this algorithm on the onset time of anesthetic drug effects.

Main Methods:

Related Experiment Videos

  • Development of a new mathematical algorithm for TCI systems focused on effect site concentration.
  • Simulation studies to analyze the time delay to peak effect for various anesthetic drugs (fentanyl, alfentanil, sufentanil, remifentanil, propofol).
  • Assessment of peak plasma concentration limitation by the proposed algorithm.

Main Results:

  • The novel algorithm can reduce the plasma overshoot, previously necessary for effect site targeting, by up to 60%.
  • This reduction in plasma concentration is associated with only a minor delay (approximately 20%) in the onset of drug effect.
  • Simulations demonstrated the algorithm's effectiveness across multiple intravenous anesthetic agents.

Conclusions:

  • The proposed TCI algorithm effectively addresses concerns regarding high plasma concentrations when targeting the drug effect site.
  • Peak plasma concentrations can be significantly reduced (up to 60%) with minimal increase in the time to peak effect.
  • This approach offers a potential improvement in managing anesthetic drug delivery and minimizing side effects.