Pharmacokinetic–pharmacodynamic modeling in anesthesia, intensive care and pain medicine

Sadean, Mihai R; Glass, Peter S. A.

doi:10.1097/aco.0b013e32832c3c6c

Cited by 16 publications

(9 citation statements)

References 29 publications

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“…The model becomes linear when =1.In this paper (Cr=remifentanil concentration, Cp =propofol concentration) is obtained by respecting Loewe additivity [7].…”

Section: Interaction Modelmentioning

confidence: 99%

“…Diverse models have been proposed for modeling the drug effect, such as experimental models, compartmental models and physiological models [6].Out of all the modeling options available, the standard modeling paradigm that has been commonly used to describe the relationship between anesthetic input and patient output is that of compartmental models. Compartmental models are formulated based on the minimum number of compartments that effectively fit the observed data [7]. Physiologically based models are more near to the actual representation of drug kinetics.…”

Section: Introductionmentioning

confidence: 99%

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Modeling, control and response surface analysis of anesthesia

Tomer

Dubey

2015

2015 International Conference on Pervasive Computing (ICPC)

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Anesthesia practice is unique in the sense that an anesthetist must target profound drug effect during any surgical stimulus and then reverse the effect rapidly when the procedure is over. This can only be achieved when the anesthetist has in depth knowledge of the relationship between concentration and effect and thus facilitate the transition between anesthetic state and awake state in a smooth way. The parameter which is used to define the right amount of anesthesia is 'Depth of Anesthesia' (DoA). A situation involving overdosing or under dosing of anesthetic drug can lead to increased costs incurred, prolonged post-operative stay in the hospitals and in extreme conditions may even lead to death. Earlier larger doses of a single anesthetic agent were used to achieve anesthesia. But it had profound side effects. As such a combination of an anesthetic agent like propofol and an opioid like remifentanil is used, and the modeling is done by a technique which is known as 'Three compartment PK-PD model'. The controller used to control the process is 'Proportional-Integral-Derivative Controller (PID).The interaction between the anesthetic drug and the opioid is then studied, so as to determine the compatibility between the two drugs. The technique which is used in this context is 'Response Surface Methodology'. In this paper Response Surface is generated using mat lab and the entire spectrum of drug effect is studied.Index Terms-Depth of anesthesia (DoA), Mat lab, PK-PD modeling, Response surface model, Synergy.

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“…The model becomes linear when =1.In this paper (Cr=remifentanil concentration, Cp =propofol concentration) is obtained by respecting Loewe additivity [7].…”

Section: Interaction Modelmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Modeling, control and response surface analysis of anesthesia

Tomer

Dubey

2015

2015 International Conference on Pervasive Computing (ICPC)

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“…[2] Prediction of therapeutically effective plasma levels is also valuable in designing rational dosage regimes in clinical psychopharmacology. [34] Models have also been devised for optimizing the dose of capecitabine for breast cancer chemotherapy,[5] prediction of therapeutically effective plasma levels of antipsychotics,[6] and prediction of the onset and duration of the pharmacological effect of diazepam. [7] …”

Section: Introductionmentioning

confidence: 99%

Comparison of three a-priori models in the prediction of serum lithium concentration

et al. 2012

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Context:Mathematical models are valuable for optimizing drug dose and dosing regimens.Aims:To compare the precision and bias of three a-priori methods in the prediction of serum level of lithium in patients with bipolar disorder, and to determine their sensitivity and specificity in detecting serum lithium levels outside the therapeutic range.Settings and Design:Hospital-based, retrospective study.Materials and Methods:In a retrospective study of 31 in-patients, the serum level of lithium was calculated using three different a-priori methods. Mean Prediction Error was used as a measure of bias while Mean Absolute Error and Root Mean Squared Error were used as a measure of precision. The sensitivity and specificity of the methods was calculated.Results:All three models underestimated serum lithium level. Precision was best with the model described by Pepin et al., while bias of prediction was the least with the method of Abou Auda et al. The formula by Pepin et al. was able to predict serum lithium level with a mean error of 36.57%. The sensitivity and specificity of the models in identifying serum lithium levels outside the therapeutic range was 80% and 76.19% for Pepin et al., 90% and 74.19% for Zetin et al., and 90% and 66.67% for Abou-Auda et al., respectively.Conclusion:The study demonstrates the difference in precision and bias of three a-priori methods, with no one method being superior to the other in the prediction of serum concentration.

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“…EDICAL Medical experience with critically ill Medical experience with critically ill patients has revealed that standard dosing guidelines often result in an inappropriate under-or over-sedation which is leading to increased mortality due to huge inter-patient pharmacological variability [1], [2], [3].Open-loop control (manual control) by clinical personnel can be tedious, imprecise, timeconsuming, and sometimes of poor quality. Hence, the need for active control (closed-loop control) in medical systems is significant, with the potential for improving the quality of medical care as well as curtailing the increasing cost of health care.…”

Section: Introductionmentioning

confidence: 99%

The effects of time-delay on feedback control of depth of anesthesia

Abdulla

Wen

2012

Proceedings of 2012 IEEE-EMBS International Conference on Biomedical and Health Informatics

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Abstract-This paper presents a new procedure to find the impact of the time-delay (TD) of the patient and instrumentations such as bispectral index (BIS) monitor on closed-loop control of depth of anaesthesia during surgery. In the current work, the TD is estimated using Smith Predictive control technique. The method is validated with measured BIS signals in simulation. The results showed that the proposed procedure improves the performance of the closed-loop system for reference tracking and overall stability, and the proposed method has less overshoot, shorter settling time and is more robust to disturbances.

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Pharmacokinetic–pharmacodynamic modeling in anesthesia, intensive care and pain medicine

Abstract: Progress was made by improving population pharmacokinetic/pharmacodynamic models, developing new indexes to measure drug effect and using them in an adaptive delivery system to the individual patient.

Cited by 16 publications

References 29 publications

Modeling, control and response surface analysis of anesthesia

Modeling, control and response surface analysis of anesthesia

Comparison of three a-priori models in the prediction of serum lithium concentration

The effects of time-delay on feedback control of depth of anesthesia

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