1.Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; 2.Department of Anesthesiology, The Third People��s Hospital of Chengdu, Chengdu 610031, China
Abstract��
OBJECTIVE To introduce the application of target controlled infusion(TCI) technique in obese population. METHODS Base on the literatures researched, we discuss the feasibility and safety of current TCI systems in obese population. RESULTS AND CONCLUSION Current TCI systems are not appropriate for obese population. Developing pharmacokinetic models which can describe pharmacokinetic properties in obese population and other various populations can realize TCI technique in obese population. And studies in physiology-based pharmacokinetic (PBPK) models may be a possible solution.
HE Juan-,
,
WANG Chen-*
.Application of Target-controlled Infusion Technique in the Obese[J] Chinese Pharmaceutical Journal, 2014,V49(14): 1185-1189
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[1]
Obesity and over weight . http://www.who.int/mediacenter/factsheet/fs311/en/[2] ABSALOM A R, KENNY G N. Closed-loop control of propofol anaesthesia using bispectral index:Performance assessment in patients receiving computer-controlled propofol and manually controlled remifentanil infusions for minor surgery . Br J Anaesth, 2003, 90(6):737-741.[3] HANLEY M J, ABERNETHY D R, GREENBLATT D J. Effect of obesity on the pharmacokinetics of drug in humans . Clin Pharmacokinet, 2010, 49(2): 71-87.[4] CHEYMOL G. Effects of obesity on pharmacokinetics implications for drug therapy . Clin Pharmacokinet, 2000, 39(3):215-231.[5] FORBES G B, WELLE S L. Lean body mass in obesity . Int J Obes, 1983, 7(2): 99-107.[6] AVRAM M J, KREJCIE T C. Using front-end kinetics to optimize target-controlled drug infusions . Anesthesiology, 2003, 99(5): 1078-1086.[7] DEMIROVIC J A, PAI A B, PAI M P. Estimation of creatinine clearance in morbidly obese patients . Am J Health Syst Pharm, 2009, 66(7): 642-648.[8] AUBERT J, BEGRICHE K, KNOCKAERT L, et al. Icreased expression of cytochrome P450 2E1 in nonalcoholic fatty liver disease: Mechanisms and pathophysiological role . Clin Res Hepatol Gastroenterol, 2011, 35(10): 630-637.[9] EGAN T D. Target-controlled drug delivery, progress toward an intravenous ��Vaporizer�� and automated anesthetic administration . Anesthesiology, 2003, 99(5): 1214-1219. GLASS P S A, SHAFER L, REVES J G. Intravenous Drug Delivery Systems. In: Miller��s Anesthesia . 7th ed. New York: Churchill Livingstone, 2009:825-858. MARSH B, WHITE M, MORTON N, et al. Pharmacokinetic model driven infusion of propofol in children . Br J Anaesth, 1991, 67(1): 41-48. SCHNIDER T W, MINTO C F, GAMBUS P L, et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers . Anesthesiology, 1998, 88(5): 1170-1182. MINTO C F, SCHNIDER T W, EGAN T D, et al. Infuence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development . Anesthesiology, 1997, 86(1): 10-23. GEPTS E, CAMU F, COCKSHOTT I D, et al. Disposition of propofol administered as constant rate intravenous infusion in humans . Anesth Analg, 1987, 66(12): 1256 -1263. COLLIS T, DEVEREUX R B, ROMAN M J, et al. Relations of stroke volume and cardiac output to body composition: The strong heart study . Circulation, 2001, 103(6): 820-825. SERVIN F, FARINOTTI R, HABERER J P, et al. Propofol infusion for maintenance of anesthesia in morbidly obese patients receiving nitrous oxide. A clinical and pharmacokinetic study . Anesthesiology, 1993, 78(4): 657-665. ABSALOM A R, MANI V, DE SMET T, et al. Pharmacokinetic models for propofol-defining and illuminating the devil in the detail . Br J Anaesth, 2009, 103(1): 26-37. GREEN B, DUFFULL S. Caution when lean body weight is used as a size descriptor for obese subjects . Clin Pharmacol Ther, 2002, 72(6): 743-744. ALBERTIN A, POLI D, LA COLLA L, et al. Predictive performance of 'Servin's formula' during BIS-guided propofol-remifentanil target-controlled infusion in morbidly obese patients . Br J Anaesth, 2007, 98(1): 66-75. SWINHOE C F, PEACOCK J E, GLEN J B, et al. Evaluation of the predictive performance of a ��Diprifusor�� TCI system . Anaesthesia, 1998, 53(suppl 1): 61-67. LA COLLA L, ALBERTIN A, LA COLLA G, et al. No adjustment vs adjustment formula as input weight for propofol target-controlled infusion in morbidly obese patients . Eur J Anaesthesiol, 2009, 26(5): 362-369. WIETASCH J K, SCHOLZ M, ZINSERLING J, et al. The performance of a target-controlled infusion of propofol in combination with remifentanil: A clinical investigation with two propofol formulations . Anesth Analg, 2006, 102(2): 430-437. JANMAHASATIAN S, DUFFULL S B, ASH S, et al. Quantification of lean body weight . Clin Pharmacokinet, 2005, 44(10): 1051-1065. LA COLLA L, ALBERTIN A, LA COLLA G, et al. Predictive performance of the ��Minto�� remifentanil pharmacokinetic parmeter set in morbidly obese patients ensuring from a new method for calculating lean body mass . Clin Pharmacokinet, 2010, 49(2): 131-139. MERTENS M J, ENGBER F H, BURM A G, et al. Predictive performance of computer-controlled infusion of remifentanil during propofol/remifentanil anesthesia . Br J Anaesth, 2003, 90(2): 132-141. COETZEE J F. Allometric or lean body mass scaling of propofol pharmacokinetic: Towards simplifying parameter ser for target-controlled infusion . Clin Pharmacokinet, 2012, 51(3):137-145. INGRANDE J, BRODSKY J B, LEMMENS H J M. Lean body weight scalar for the anesthetic induction dose of propofol in morbidly obese subjects . Anesth Analg, 2011, 113(1): 57-62. PELLIS T, LEYKIN Y, ALBANO G, et al. Perioperative management and monitoring of a super-obese patient . Obes Surg, 2004, 14(10): 1423-1428. EGAN T D, HUIZINGA B, GUPTA S K, et al. Remifentanil pharmacokinetics in obese versus lean patients . Anesthesiology, 1998, 89(3): 562-573. ERRANDO C L, SIGL J C, ROBLES M, et al. Awareness with recall during general anaesthesia: A prospective observational evaluation of 4001 patients . Br J Anaesth, 2008, 101(2): 178-185. BERGLANGD A, GISLANSON H, RAEDER J. Fast-track surgery for bariatric laparoscopic gastric bypass with focus on anaesthesia and peri-operative care. Experience with 500 cases . Acta Anaesthesiol Scand, 2008, 52(10):1394-1399. VAN KRALINGEN S, DIEPSTRATEN J, PEETER M Y, et al. Population pharmacodynamics of propofol in morbidly obese patients . Clin Pharmacokinet, 2011, 50(11): 739-750. CORTINEZ L I, ANDERSON B J, PENNA A, et al. Influence of obesity on propofol pharmacokinetic derivation of a pharmacokinetic model . Br J Anaesth, 2010, 105(4): 448-456. LA COLLA L, ALBERTIN A, LA COLLA C G. Pharmacokinetic model-driven remifentanil administration in the morbidly obese: The ��critical weight�� and the ��fictitious height��, a possible solution to an unsolved problem . Clin Pharmacokinet, 2009, 48(6): 397-398. LEVITT D G, SCHNIDER T W. Human physiologically based pharmacokinetic model for propofol . BMC Anesthesiol, 2005, 5(1):4. EDGINTON A N, SCHMITT W, WILLMANN S. Application of physiology-based and pharmacodynamic modeling to individualized target-controlled propofol infusion . Adv Ther, 2006, 23(1): 143-158. MASUI K, UPTON R N, DOUFAS A G, et al. The performance of compartmental and physiologically based recirculatory pharmacokinetic models for propofol: A comparison using bolus, continuous, and target-controlled infusion data . Anesth Analg, 2010,111(2): 368-379. UPTON R N, LUDROLLK G. A physiologically based recirculatory model of the kinetics and dynamics of propofol in man . Anesthesiology, 2005, 103(2): 344-352.
2014, Vol. 49 
