Advances in pharmacokinetic modeling: target controlled infusions in the obese.

Show simple item record Cortínez, Luis I en Anderson, Brian en 2018-12-06T02:30:56Z en 2018-08 en
dc.identifier.issn 0952-7907 en
dc.identifier.uri en
dc.description.abstract PURPOSE OF REVIEW:The use of conventional pharmacokinetic parameters sets 'models' derived from nonobese patients has proven inadequate to administer intravenous anesthetics in the obese population and is commonly associated with higher than anticipated plasma propofol concentrations when used with target (plasma or effect site) controlled infusion pumps. In this review we will describe recent modeling strategies to characterize the disposition of intravenous anesthetics in the obese patient and will show clinically relevant aspects of new model's performance in the obese population. RECENT FINDINGS:Because clearance of a drug increases in a nonlinear manner with weight, nonlinear relationships better scale infusion rates between lean and obese individuals. Allometric concepts have been successfully used to describe size-related nonlinear changes in clearances. Other nonlinear scaling options include the use of descriptors such as body surface area, lean body weight, fat-free mass, and normal fat mass. Newer pharmacokinetic models, determined from obese patient data, have been developed for propofol and remifentanil using allometric concepts and comprehensive size descriptors. SUMMARY:Pharmacokinetic models to perform target-controlled infusion in the obese population should incorporate descriptors that reflect with greater precision the influence of body composition in volumes and clearances of each drug. It is our hope that commercially available pumps will soon incorporate these new models to improve the performance of this technique in the obese population. en
dc.format.medium Print en
dc.language eng en
dc.relation.ispartofseries Current opinion in anaesthesiology en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri en
dc.subject Humans en
dc.subject Obesity en
dc.subject Body Weight en
dc.subject Propofol en
dc.subject Piperidines en
dc.subject Anesthetics, Intravenous en
dc.subject Body Mass Index en
dc.subject Body Composition en
dc.subject Patient-Specific Modeling en
dc.title Advances in pharmacokinetic modeling: target controlled infusions in the obese. en
dc.type Journal Article en
dc.identifier.doi 10.1097/aco.0000000000000619 en
pubs.issue 4 en
pubs.begin-page 415 en
pubs.volume 31 en
dc.rights.holder Copyright: The author en
pubs.end-page 422 en
pubs.publication-status Published en
dc.rights.accessrights en
pubs.subtype Review en
pubs.subtype Journal Article en
pubs.elements-id 750384 en Medical and Health Sciences en School of Medicine en Anaesthesiology en
dc.identifier.eissn 1473-6500 en
pubs.record-created-at-source-date 2018-05-26 en
pubs.dimensions-id 29794852 en

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