Abstract - Institute of Pharmacology

Pharmacological Reports
Copyright © 2012
2012, 64, 782–795
by Institute of Pharmacology
ISSN 1734-1140
Polish Academy of Sciences
Review
Potential pitfalls of propofol target controlled
infusion delivery related to its pharmacokinetics
and pharmacodynamics
Agnieszka Bienert1, Pawe³ Wiczling2, Edmund Grzeœkowiak1,
Jacek B. Cywiñski3, Krzysztof Kusza4
1
Department of Clinical Pharmacy and Biopharmacy, Karol Marcinkowski University of Medical Sciences,
Marii Magdaleny 14, PL 61-861 Poznañ, Poland
2
Department of Biopharmaceutics and Pharmacodynamics, Medical Univeristy of Gdañsk, Hallera 107,
PL 80-401, Gdañsk, Poland
3
Departments of General Anesthesiology and Outcome Research, Cleveland Clinic, 9500 Euclid
Avenue,
Cleveland, Ohio 44195, USA
4
Department of Anesthesiology and Intensive Therapy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus
University in Toruñ, Marii Sk³odowskiej-Curie 9, PL 85-094 Bydgoszcz, Poland
Correspondence: Agnieszka Bienert, e-mail: [email protected]
Abstract:
Target controlled infusion (TCI) devices are increasingly used in clinical practice. These devices unquestionably aid optimization of
drug dosage. However, it still remains to be determined if they sufficiently address differences in pharmacological make up of individual patients. The algorithms guiding TCI pumps are based on pharmacological data obtained from a relatively small number of
healthy volunteers, which are then extrapolated, on the basis of sophisticated pharmacokinetic and pharmacodynamic modeling, to
predict plasma concentrations of the drug and its effect on general population. One has to realize the limitation of this approach: these
models may be less accurate when applied to patients in extreme clinical conditions: in intensive care units, with a considerable loss
of blood, severe hypothermia or temporary changes in the composition of plasma, e.g., hypoalbuminemia. In the future, data obtained under these “extreme” clinical circumstances, may be used to modify the dosage algorithms of propofol TCI systems to match
the clinical scenario.
Key words:
propofol, TCI systems, pharmacokinetics, pharmacodynamics
782
Pharmacological Reports, 2012, 64,
782–795