发表的罗库的药理动力学/药理动力学模型的神经肌肉终点预测能力:一个观察性试验
Hugo Carvalho1, Michaël Verdonck2, Douglas J Eleveld3
1Department of Anesthesia and Perioperative Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium; Department of Anesthesiology and Reanimation, AZ Sint Jan Brugge-Oostende, Belgium.
Journal of clinical anesthesia
|August 5, 2023
概括
已发表的罗库的药理动力学/药理动力学模型无法准确预测手术内神经肌肉功能. 这些模型高估了四次训练 (TOF) 比率,表明需要在神经肌肉管理中提高预测准确度.
科学领域:
- 麻醉学 麻醉学
- 药理学 药理学是指药理学的学科.
- 临床监测 临床监测
背景情况:
- 神经肌肉监测对于外科手术期间的管理至关重要.
- 药理动力学 (PK) 和药理动力学 (PD) 建模可能会增强神经肌肉管理.
- 这项研究评估了用于预测神经肌肉阻塞的罗库PK/PD模型.
研究的目的:
- 评估已发表的罗库PK/PD模型的预测性能.
- 为了将模型预测与电肌图学四列列车 (TOF) 测量进行比较.
- 评估这些模型在实时的手术内设置中的准确性.
主要方法:
- 观察性试验包括74名接受全身麻醉的患者.
- 使用了持续的电动肌图 (EMG) 神经肌肉监测.
- 用PK/PD模拟的TOF比率与使用Varvel标准测量的EMG TOF比率进行了比较.
主要成果:
- 发表的罗库PK/PD模型通常高估了手术内TOF比率.
- 五个模型 (Wierda,Szenohradszky,Cooper,Alvarez-Gomez,McCoy) 的绝对误差中位数为38-41%.这些模型中的平均误差为38-41%.
- 克莱恩模型表现出更好的性能 (16%的误差),但所有模型都有广泛的置信区间,表明了可变的准确性.
结论:
- 目前公布的罗库PK/PD模型无法准确预测手术内TOF比率的动态.
- 这些模型的高估凸显了它们在精确神经肌肉管理中的临床适用性方面的局限性.
- 需要对PK/PD模型进行进一步的改进,以改善神经肌肉阻断逆转的预测.
相关概念视频
01:17Nondepolarizing (Competitive) Neuromuscular Blockers: Mechanism of Action
1.9K
Nondepolarizing neuromuscular blockers induce paralysis by competitively blocking nicotinic acetylcholine receptors at the muscle end plate. Examples include pancuronium, mivacurium, vecuronium, and rocuronium. These quaternary ammonium derivatives are administered intravenously, are poorly absorbed, and are excreted via the kidneys.
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
Competitive antagonists prevent acetylcholine from binding to its receptor, inhibiting membrane depolarization. Without conformational changes or intrinsic...
1.9K
01:26Pharmacokinetic Models: Comparison and Selection Criterion
104
Physiological and compartmental models are valuable tools used in studying biological systems. These models rely on differential equations to maintain mass balance within the system, ensuring an accurate representation of the dynamic processes at play.
Physiological models take a detailed approach by considering specific molecular processes. They can predict drug distribution, metabolism, and elimination changes, providing a comprehensive understanding of how drugs interact with the body.
Physiological models take a detailed approach by considering specific molecular processes. They can predict drug distribution, metabolism, and elimination changes, providing a comprehensive understanding of how drugs interact with the body.
104
01:11Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacokinetics
478
All neuromuscular blocking agents are injected intravenously because they are poorly absorbed from the GI tract. Rapid onset is achieved with intravenous administration, although absorption is also adequate from an intramuscular injection. Since these agents are highly ionized, they do not readily penetrate cell membranes or cross the blood-brain barrier.
Instead, they are transported by the blood to different tissues. Muscles with a greater blood supply (arteries) and blood flow receive more...
Instead, they are transported by the blood to different tissues. Muscles with a greater blood supply (arteries) and blood flow receive more...
478
01:20Pharmacokinetic Models: Overview
786
Pharmacokinetic models utilize mathematical analysis to achieve a detailed quantitative understanding of a drug's life cycle within the body. They are instrumental in simulating a drug's pharmacokinetic parameters, predicting drug concentrations over time, optimizing dosage regimens, linking concentrations with pharmacologic activity, and estimating potential toxicity.
There are three primary types of models: empirical, compartment, and physiological. Empirical models, with minimal...
There are three primary types of models: empirical, compartment, and physiological. Empirical models, with minimal...
786
00:59Model-Independent Approaches for Pharmacokinetic Data: Noncompartmental Analysis
95
Noncompartmental analyses offer an alternative method for describing drug pharmacokinetics without relying on a specific compartmental model. In this approach, the drug's pharmacokinetics are assumed to be linear, with the terminal phase log-linear. This assumption allows for simplified analysis and interpretation of the drug's behavior in the body.
One important characteristic of noncompartmental analyses is that drug exposure increases proportionally with increasing doses. This...
One important characteristic of noncompartmental analyses is that drug exposure increases proportionally with increasing doses. This...
95
01:27Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions
457
Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
Although all competitive neuromuscular blockers are designed...
457