Early Phase Pharmacokinetics but Not Pharmacodynamics Are Influenced by Propofol Infusion Rate

• Published in: Anesthesiology (Philadelphia) Vol. 111; no. 4; pp. 805 - 817
• Main Authors: MASUI, Kenichi, KIRA, Marimo, KAZAMA, Tomiei, HAGIHIRA, Satoshi, MORTIER, Eric P, STRUYS, Michel M. R. F
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.10.2009
• Subjects: Adult; Aged; Algorithms; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Intravenous - administration & dosage; Anesthetics, Intravenous - pharmacokinetics; Anesthetics, Intravenous - pharmacology; Bayes Theorem; Biological and medical sciences; Dose-Response Relationship, Drug; Electroencephalography - drug effects; Female; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - pharmacokinetics; Hypnotics and Sedatives - pharmacology; Infusions, Intravenous; Male; Medical sciences; Middle Aged; Models, Statistical; Monitoring, Intraoperative; Propofol - administration & dosage; Propofol - pharmacokinetics; Propofol - pharmacology; Anesthesia; Propofol; General anesthetic; Pharmacokinetics; Early phase
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0b013e3181b799c1

Conventional compartmental pharmacokinetic models wrongly assume instantaneous drug mixing in the central compartment, resulting in a flawed prediction of drug disposition for the first minutes, and the flaw affects pharmacodynamic modeling. This study examined the influence of the administration rate and other covariates on early phase kinetics and dynamics of propofol by using the enlarged structural pharmacokinetic model. Fifty patients were randomly assigned to one of five groups to receive 1.2 mg/kg propofol given with the rate of 10 to 160 mg . kg(-1). h(-1). Arterial blood samples were taken frequently, especially during the first minute. The authors compared four basic pharmacokinetic models by using presystemic compartments and the time shift of dosing, LAG time. They also examined a sigmoidal maximum possible drug effect pharmacodynamic model. Patient characteristics and dose rate were obtained to test the model structure. Our final pharmacokinetic model includes two conventional compartments enlarged with a LAG time and six presystemic compartments and includes following covariates: dose rate for transit rate constant, age for LAG time, and weight for central distribution volume. However, the equilibration rate constant between central and effect compartments was not influenced by infusion rate. This study found that a combined pharmacokinetic-dynamic model consisting of a two-compartmental model with a LAG time and presystemic compartments and a sigmoidal maximum possible drug effect model accurately described the early phase pharmacology of propofol during infusion rate between 10 and 160 mg . kg(-1). h(-1). The infusion rate has an influence on kinetics, but not dynamics. Age was a covariate for LAG time.