General purpose propofol target-controlled infusion using the marsh model with adjusted weight input

Area of Science:

• Anesthesiology
• Pharmacokinetics
• Medical Informatics

Background:

• Target-controlled infusion (TCI) models are crucial for precise anesthetic drug delivery.
• The Marsh TCI model has limitations in accuracy for patients at the extremes of age and body mass index.
• The Eleveld model offers improved accuracy but is not yet widely implemented.

Purpose of the Study:

• To develop and validate a simple weight adjustment method for the Marsh TCI model.
• To enhance the precision of the Marsh model, particularly for pediatric and geriatric populations.
• To enable the Marsh model to closely mimic the performance of the Eleveld model.

Main Methods:

• A novel weight adjustment algorithm was applied to the Marsh TCI model.
• Simulations were conducted on 2768 virtual subjects with varied demographics (age, weight, height, sex).
• The performance of the weight-adjusted Marsh model was compared against the Eleveld model using propofol TCI simulations.

Main Results:

• The weight-adjusted Marsh model demonstrated infusion regimes and effect-site concentrations highly similar to the Eleveld model.
• Median absolute performance error was below 8.1%, and maximum absolute performance error was below 20.3% across all simulated subjects.
• The method proved effective in improving the Marsh model's precision for diverse patient populations.

Conclusions:

• The proposed weight adjustment method offers a simple and robust enhancement for the Marsh TCI model.
• This modification significantly improves the Marsh model's accuracy for patients at the extremes of age and body mass index.
• The adjusted Marsh model serves as a valuable alternative until more advanced TCI models are commercially available.