Pharmacokinetic Pharmacodynamic Modelling Contributions to Improve Paediatric Anaesthesia Practice

被引:4
作者
Morse, James D. [1 ]
Ignacio Cortinez, Luis [2 ]
Anderson, Brian J. [1 ]
机构
[1] Univ Auckland, Dept Anaesthesiol, Pk Rd, Auckland 1023, New Zealand
[2] Pontificia Univ Catolica Chile, Div Anestesiol, Escuela Med, San Diego De Chile 8331150, Chile
关键词
anaesthetics; intravenous; paediatrics; anaesthetic techniques; TIVA; target-controlled infusion; pharmacokinetics; pharmacodynamics; nonlinear mixed-effects models; PATIENT-CONTROLLED ANALGESIA; TARGET-CONTROLLED INFUSION; DRUG-METABOLIZING-ENZYMES; END-TIDAL SEVOFLURANE; POPULATION PHARMACOKINETICS; BISPECTRAL INDEX; DEXMEDETOMIDINE PHARMACOKINETICS; REMIFENTANIL PHARMACOKINETICS; DYNAMIC RELATIONSHIP; DOSE ADJUSTMENT;
D O I
10.3390/jcm11113009
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The use of pharmacokinetic-pharmacodynamic models has improved anaesthesia practice in children through a better understanding of dose-concentration-response relationships, developmental pharmacokinetic changes, quantification of drug interactions and insights into how covariates (e.g., age, size, organ dysfunction, pharmacogenomics) impact drug prescription. Simulation using information from these models has enabled the prediction and learning of beneficial and adverse effects and decision-making around clinical scenarios. Covariate information, including the use of allometric size scaling, age and consideration of fat mass, has reduced population parameter variability. The target concentration approach has rationalised dose calculation. Paediatric pharmacokinetic-pharmacodynamic insights have led to better drug delivery systems for total intravenous anaesthesia and an expectation about drug offset when delivery is stopped. Understanding concentration-dependent adverse effects have tempered dose regimens. Quantification of drug interactions has improved the understanding of the effects of drug combinations. Repurposed drugs (e.g., antiviral drugs used for COVID-19) within the community can have important effects on drugs used in paediatric anaesthesia, and the use of simulation educates about these drug vagaries.
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页数:20
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