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A Simulation Study of Propofol Effect-Site Concentration for Appropriate Sedation in Pediatric Patients Undergoing Brain MRI: Pharmacodynamic Analysis.

Authors
 Se Hee Na  ;  Young Song  ;  So Yeon Kim  ;  Hyo-Jin Byon  ;  Hwan-Ho Jung  ;  Dong Woo Han 
Citation
 Yonsei Medical Journal, Vol.58(6) : 1216-1221, 2017 
Journal Title
 Yonsei Medical Journal 
ISSN
 0513-5796 
Issue Date
2017
MeSH
Adolescent ; Anesthesia ; Anesthetics, Intravenous/administration & dosage ; Anesthetics, Intravenous/pharmacology ; Bradycardia/complications ; Brain/diagnostic imaging* ; Child ; Dose-Response Relationship, Drug ; Female ; Humans ; Hypnotics and Sedatives/administration & dosage ; Hypnotics and Sedatives/pharmacology* ; Hypotension/chemically induced ; Magnetic Resonance Imaging ; Male ; Models, Biological* ; Probability ; Propofol/administration & dosage ; Propofol/pharmacology*
Keywords
Effect-site concentration ; magnetic resonance imaging ; population pharmacodynamics modelling ; propofol ; sedation ; simulation
Abstract
PURPOSE: We aimed to establish the propofol effect-site concentration (Ce) for appropriate sedation by pharmacodynamic analysis and to determine the propofol Ce during occurrence of sedation-related side effects in pediatric patients undergoing brain magnetic resonance imaging (MRI). MATERIALS AND METHODS: In 50 pediatric patients scheduled for brain MRI, sedation was induced with 2.0 mg/kg propofol; additional propofol doses were 0.5-1 mg/kg. Propofol Ce was simulated by inputting the propofol administration profiles of patients into a pediatric compartmental model (Choi model). The relationship between propofol Ce and probabilities of sedation and recovery were analyzed using a sigmoidal Emax model. The simulated propofol Ce for sedation-related side effects was investigated. Population model parameters were estimated using the Nonlinear Mixed-Effects Modelling software. RESULTS: The mean values of propofol Ce₅₀ for sedation during the preparation, scanning, and recovery phases were 1.23, 0.43, and 0.39 μg/mL. The simulated propofol Ce values during oxygen desaturation (SpO₂ <90%) (3 patients; 6%), hypotension (16 patients; 32%), and bradycardia (12 patients; 24%) were 3.01±0.04, 2.05±0.63, and 2.41±0.89 μg/mL, respectively. CONCLUSION: The required propofol Ce₅₀ for applying monitors during the preparation phase before the start of MRI was higher than the propofol Ce₅₀ required during the scanning phase. During low-intensity stimulation phases, such as scanning, propofol bolus dose should be strictly titrated not to exceed the propofol Ce that can lead to oxygen desaturation because of the relatively low propofol Ce (Ce₉₅, 1.43 μg/mL) required for sedation in most patients.
DOI
10.3349/ymj.2017.58.6.1216
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
김소연(Kim, So Yeon) ORCID logo https://orcid.org/0000-0001-5352-157X
라세희(Na, Se Hee) ORCID logo https://orcid.org/0000-0003-4208-0769
변효진(Byon, Hyo Jin)
송영(Song, Young) ORCID logo https://orcid.org/0000-0003-4597-387X
정환호(Jung, Hwan Ho) ORCID logo https://orcid.org/0000-0002-3819-2744
한동우(Han, Dong Woo) ORCID logo https://orcid.org/0000-0002-8757-663X
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/161336
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