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A pharmacodynamic model of respiratory rate and end-tidal carbon dioxide values during anesthesia in children

Ji-Hyun Lee1, Pyo-Yoon Kang1, Young-Eun Jang1

  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.

Acta Pharmacologica Sinica
|September 1, 2018
PubMed

Insights

Monitoring end-tidal carbon dioxide (ETCO2) is crucial during pediatric general anesthesia. Children on antiepileptic drugs require a lower respiratory rate (RR) to achieve target ETCO2 levels compared to non-users.

Area of Science:

  • Anesthesiology
  • Pharmacodynamics
  • Pediatric Critical Care

Background:

  • End-tidal carbon dioxide (ETCO2) monitoring is vital for managing ventilation during general anesthesia.
  • Understanding the relationship between respiratory rate (RR) and ETCO2 is essential for optimizing patient care.

Purpose of the Study:

  • To establish the relationship between RR and ETCO2 in pediatric patients under general anesthesia.
  • To identify clinical variables, specifically antiepileptic drug (AED) use, influencing this relationship.

Main Methods:

  • A prospective observational study involving 51 pediatric patients (≤12 years) undergoing general anesthesia.
  • Population pharmacodynamic modeling using a sigmoid Emax model to analyze RR-ETCO2 data.
  • Comparison between AED users (n=21) and non-users (n=30).

Main Results:

  • A distinct hysteresis was observed between RR and ETCO2.
  • The RR required to achieve a target ETCO2 of 35 mmHg (Ce50) was significantly lower in AED users (14.9 breaths/min) than non-users (20.5 breaths/min).
  • Model parameters, including gamma (γ) and keo, were determined.

Conclusions:

  • Children on antiepileptic drugs require a lower respiratory rate to achieve target end-tidal carbon dioxide levels during general anesthesia.
  • Pharmacodynamic modeling effectively characterizes the RR-ETCO2 relationship in this population.

Keywords:
antiepileptic drugsend-tidal carbon dioxidepediatric anesthesiapopulation pharmacodynamic modelingrespiratory rate

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