What does this research mean for the field?

Using the Schüttler and Ihmsen population pharmacokinetic parameter set for target-controlled infusion of propofol in elderly patients causes inappropriately low blood concentrations and increases the risk of intraoperative awareness. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

December 1, 2000AnesthesiologyOpen Access

Population Pharmacokinetics of Propofol for Target-controlled Infusion (TCI) in the Elderly

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Propofol target-controlled infusion (n=270). Intervention: Schüttler and Ihmsen pharmacokinetic parameter set for propofol TCI vs. Previous parameter sets (Dyck and Shafer, Schnider et al., Oostwouder et al.). Primary outcome: Predicted propofol concentration.

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Key result

Using the Schüttler and Ihmsen population pharmacokinetic parameter set for target-controlled infusion in the elderly may cause unwanted low propofol concentrations, increasing awareness risk.

Why the study?

Does the Schüttler and Ihmsen pharmacokinetic parameter set accurately predict propofol concentrations for target-controlled infusion in elderly patients compared to previous models?

Population

Elderly patients receiving propofol for target-controlled infusion. The critiqued study included 270…

Comparison

Propofol target-controlled infusion using the… vs Propofol TCI using previously described…

Design

Editorial

Authors

JVJaap VuykLeiden University Medical Center TSThomas W. SchniderKantonsspital St. Gallen FEFrank H. M. EngbersUniversity Medical Center Groningen

Discussion

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Implication

The Schüttler and Ihmsen pharmacokinetic parameter set is unsuitable and potentially harmful for target-controlled infusion of propofol in elderly patients due to inaccurate predictions of clearance and distribution.

Structured PICO

Does the Schüttler and Ihmsen pharmacokinetic parameter set accurately predict propofol concentrations for target-controlled infusion in elderly patients compared to previous models?

Population

270 patients from a previously published dataset, including approximately 10% aged 65 years or older and 35% aged 11 years or younger, evaluated for propofol pharmacokinetics.

Intervention

Propofol target-controlled infusion (TCI) using the Schüttler and Ihmsen population pharmacokinetic parameter set

Comparator

Propofol TCI using previously described parameter sets (Dyck and Shafer, Schnider et al., Oostwouder et al.)

Outcome

Predicted blood and effect-site propofol concentrationssurrogate

Limitations

Only a small minority of patients were aged 65 yr or older (approximately 10%).
Concentration-time data for elderly patients were gathered only for a mean period of 55 min.
The article lacks a retrospective or prospective validation of the parameter set.
Lack of concentration-time data from a significant number of elderly patients
Short data gathering period (mean 55 min) for elderly patients
Lack of retrospective or prospective validation of the parameter set

Cite This Study

Vuyk et al. (2000) conducted a letter in Propofol target-controlled infusion (n=270). Schüttler and Ihmsen pharmacokinetic parameter set for propofol TCI vs. Previous parameter sets (Dyck and Shafer, Schnider et al., Oostwouder et al.) was evaluated on Predicted propofol concentration. Using the Schüttler and Ihmsen population pharmacokinetic parameter set for target-controlled infusion in the elderly may cause unwanted low propofol concentrations, increasing awareness risk.

synapsesocial.com/papers/6aaa317ebf5b892176fca970 https://doi.org/10.1097/00000542-200012000-00049

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Population Pharmacokinetics of Propofol for Target-controlled Infusion (TCI) in the Elderly

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Population Pharmacokinetics of Propofol for Target-controlled Infusion (TCI) in the Elderly

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

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