The role of pharmacokinetics and pharmacodynamics in clinical anaesthesia practice.

Current Opinion in Anaesthesiology
Laura N HannivoortMichel M R F Struys

Abstract

Growing concerns about the environmental effects of volatile anaesthetics are likely to lead to increased use of intravenous anaesthetic drugs. Pharmacokinetic/pharmacodynamic (PKPD) models can increase the accuracy of intravenous drug titration, especially in populations that differ from the 'average.' However, with a growing number of PKPD models, and other technology available to date, it can be hard to see the wood for the trees. This review attempts to guide the reader through the PKPD jungle. General purpose PKPD models for propofol and remifentanil designed to apply to a broader population, including children, the elderly and the obese, reduce the need for population-specific models. PKPD models for drugs such as dexmedetomidine and antimicrobial agents may be useful for procedural sedation or in the ICU. Technological advances such as Bayesian model adjustment based on point-of-care plasma concentration measurements, closed-loop drug delivery and artificial intelligence may improve the ease of use of the anaesthetic drugs and increase the accuracy of titration. Newer and more complex modelling techniques and technological advancements can help to deliver anaesthetic drugs, sedatives and other drugs in a more stable and ...Continue Reading

References

Jul 1, 1991·British Journal of Anaesthesia·B MarshG N Kenny
Jan 1, 1987·The Journal of Pharmacology and Experimental Therapeutics·J C Scott, D R Stanski
Dec 1, 1995·Anesthesiology·E GeptsJ J Heykants
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Sep 25, 2003·British Journal of Anaesthesia·A AbsalomG N C Kenny
Jun 9, 2005·British Journal of Anaesthesia·A Absalom, G Kenny
Sep 11, 2009·Anesthesiology·Peter M SchumacherMichel M R F Struys
Jun 4, 2010·Anesthesia and Analgesia·Susan M Ryan, Claus J Nielsen
Oct 12, 2010·British Journal of Anaesthesia·M P Sulbaek AndersenT J Wallington
Jan 10, 2012·Anesthesiology·Bjorn HeyseMichel M R F Struys
Mar 1, 2012·Analytical and Bioanalytical Chemistry·Cyrill HornussGustav Schelling
Apr 12, 2014·Anesthesia and Analgesia·Douglas J EleveldMichel M R F Struys
May 6, 2015·Clinical Pharmacokinetics·Hesham Saleh Al-SallamiStephen Brent Duffull
Jan 19, 2017·Anesthesia and Analgesia·Robert G Loeb, Maxime Cannesson
May 17, 2017·Anesthesiology·Douglas J EleveldMichel M R F Struys
May 17, 2017·Anesthesiology·Tae Kyun KimUNKNOWN the Remifentanil Pharmacokinetics in Obesity Investigators
Sep 1, 2017·British Journal of Anaesthesia·P J ColinM M R F Struys
Oct 14, 2017·British Journal of Anaesthesia·J P van den BergM M R F Struys
Nov 23, 2017·Anesthesiology·Pedro Gambus, Steven L Shafer
Dec 7, 2017·Anesthesia and Analgesia·Nicholas WestRichard N Merchant

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Citations

May 31, 2021·Current Opinion in Anaesthesiology·Sabine Himmelseher, Eberhard F Kochs

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