This study presents a systematic review conducted according to the PRISMA 2020 guidelines, evaluating pharmacokinetic-pharmacodynamic (PK-PD) models for target-controlled infusion (TCI) of propofol. A structured search was performed across PubMed, Summon, Google Scholar, Web of Science, and Scopus, identifying 427 sources, of which 17 met the inclusion criteria. The analysis revealed that nine studies compared existing models, six focused on the development of new PK-PD models, and two explored broader implications of TCI in anesthesia. Comparative studies indicate that while the Eleveld model generally offers superior predictive accuracy, it does not consistently outperform the Marsh and Schnider models across all populations. The Schnider model demonstrated better bias control in elderly patients, while the Eleveld model improved drug clearance estimation in obese patients. However, inconsistencies remain in predicting brain concentrations of propofol. Newly proposed models introduce adaptive dosing strategies, incorporating allometric scaling, lean body weight, and machine learning techniques, yet require further external validation. The results highlight ongoing challenges in achieving universal applicability of TCI models, underscoring the need for future research in refining precision dosing and personalized anesthesia management.
- MeSH
- Anesthetics, Intravenous * administration & dosage pharmacokinetics pharmacology MeSH
- Models, Biological MeSH
- Infusions, Intravenous MeSH
- Humans MeSH
- Propofol * administration & dosage pharmacokinetics pharmacology MeSH
- Machine Learning MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Systematic Review MeSH
Emergentní delirium (ED) je častá pooperační komplikace u dětí, která se projevuje dezorientací, poruchou percepce a psychomotorickým neklidem. Incidence emergentního deliria je uváděna 10–50 %. Ačkoliv je ED self-limiting stavem, může způsobit řadu pooperačních komplikací včetně sebepoškození, dehiscence operační rány, krvácení a dalších obtíží pro ošetřující personál. I přes rozsáhlý výzkum zůstává přesná patofyziologie vzniku ED neznámá. PAED skóre je jediným validovaným nástrojem pro diagnostiku ED. Tento přehledový článek shrnuje rizikové faktory vzniku ED a současné možnosti jeho farmakologické a nefarmakologické prevence a léčby. Korespondující autor: doc. MUDr. Jan Pavlíček, Ph.D., MHA Klinika dětského lékařství Fakultní nemocnice Ostrava Tř. 17. listopadu 1789 708 52 Ostrava-Poruba jan.pavlicek@fno.cz
Emergence delirium (ED) is a common postoperative complication in children, characterized by desorientation, perception and psychomotor disorder. The described incidence of emergence delirium varies between 10-50 %. Although ED is self-limiting, it can induce postoperative complications, including self-injury, dehiscence of surgical wound, bleeding and other difficulties for medical staff. Despite extensive research of ED, precise pathophysiology remains uknown. PAED score is only validated tool for ED diagnosis. This review summarizes the risk factors of ED development and provide current options of pharmacologic and non-pharmacologic prevention and treatment.
- MeSH
- Anesthetics, Intravenous administration & dosage MeSH
- Anesthesia, General * adverse effects MeSH
- Child MeSH
- Hypnotics and Sedatives administration & dosage MeSH
- Humans MeSH
- Emergence Delirium * diagnosis drug therapy physiopathology prevention & control MeSH
- Risk Factors MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Review MeSH
OBJECTIVE: To compare changes in oesophageal (T-Oeso) and rectal (T-Rec) temperature in dogs during general anaesthesia and premedicated with fentanyl, medetomidine-fentanyl or acepromazine-fentanyl. STUDY DESIGN: Prospective, randomized, blind clinical study. ANIMALS: A total of 120 healthy dogs, aged 2-10 years and weighing 5-20 kg. METHODS: Dogs were randomly allocated to one of three groups. Animals of F group were premedicated with fentanyl (0.01 mg kg-1), MF group with medetomidine (0.005 mg kg-1) and fentanyl (0.01 mg kg-1) and AF group with acepromazine (0.01 mg kg-1) and fentanyl (0.01 mg kg-1). Anaesthesia was induced with propofol and maintained with isoflurane in oxygen-air mixture. Fentanyl was administered continuously (0.01 mg kg-1 hour-1). The T-Oeso, T-Rec and ambient temperatures were recorded after induction (T0) and subsequently at 10 minute intervals for 60 minutes (T10-T60). Data were analysed using anova or their non-parametric equivalents (p < 0.05). RESULTS: Median T-Oeso was significantly higher in MF group between T0-T20 compared with other groups. Median T-Oeso significantly decreased in F group from 38.0 °C (T0) to 37.4 °C (T30), 37.1 °C (T40), 36.9 °C (T50) and 36.6 °C (T60), in MF group from 38.3 °C (T0) to 37.7 °C (T30), 37.5 °C (T40), 37.2 °C (T50) and 37.1 °C (T60) and in AF group from 37.7 °C (T0) to 37.3 °C (T40), 37.2 °C (T50) and 37.1 °C (T60). The T-Rec significantly decreased in F group from 38.0 °C (T0) to 37.4 °C (T40), 37.2 °C (T50) and 36.9 °C (T60), in MF group from 38.3 °C (T0) to 37.5 °C (T50) and 37.4 °C (T60) and in AF group from 38.2 °C (T0) to 37.6 °C (T40), 37.5 °C (T50) and 37.4 °C (T60). CONCLUSIONS AND CLINICAL RELEVANCE: Premedication with fentanyl, medetomidine-fentanyl or acepromazine-fentanyl in the doses used decreased the T-Oeso and T-Rec. The T-Oeso at the beginning of anaesthesia was higher after premedication with medetomidine-fentanyl. However, this difference was not clinically significant.
- MeSH
- Acepromazine * pharmacology administration & dosage MeSH
- Anesthetics, Intravenous pharmacology administration & dosage MeSH
- Anesthesia, General veterinary MeSH
- Esophagus drug effects MeSH
- Fentanyl * pharmacology administration & dosage MeSH
- Anesthetics, Combined administration & dosage pharmacology MeSH
- Medetomidine * pharmacology administration & dosage MeSH
- Preanesthetic Medication veterinary MeSH
- Prospective Studies MeSH
- Dogs MeSH
- Rectum MeSH
- Body Temperature * drug effects MeSH
- Animals MeSH
- Check Tag
- Male MeSH
- Dogs MeSH
- Female MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial, Veterinary MeSH
- MeSH
- Anesthetics, General administration & dosage MeSH
- Anesthetics * administration & dosage MeSH
- Anesthesia, Intravenous methods MeSH
- Humans MeSH
- Decision Making, Computer-Assisted MeSH
- Drug Administration Schedule MeSH
- Medical Informatics Applications MeSH
- Check Tag
- Humans MeSH
- Publication type
- Newspaper Article MeSH
V uvedenom článku je v nadväznosti na už publikovaný prehľad o celkových inhalačných anestetikách pozornosť venovaná intravenóznym (vnútrožilným) anestetikám. Z chemického hľadiska ide o štruktúrne rôznorodú kategóriu, ako sú barbiturátové deriváty − tiopental (Sodium pentothal®, Trapanal®, Pentothal®), metohexital (Brevital®), hexobarbital (Evipan®, Hexenal®, Citopan®, Tobinal®), nebarbiturátové deriváty − ketamín (Ketalar® Ketaset®), esketamín (Ketanest®) a etomidát (Amidate®, Hypnomidate®), deriváty fenolu − propofol (Diprivan®) a steroidné deriváty – zmes alfadolónu a alfaxalónu (Althesin® v humánnej a Saffan® vo veterinárnej anestézii), deriváty kyseliny fenyloctovej − propanidid (Epontol®, Sombrevin®). S výnimkou propofolu a propanididu ide väčšinou o chirálne zlúčeniny, ktoré sa okrem etomidátu a esketamínu používajú vo forme racemátov. U uvedených anestetík je pozornosť venovaná okrem ich charakteristiky a mechanizmu účinku aj ich chirálnym vlastnostiam.
In continuation of our published review on general inhalational anesthetics, the current article presents a survey of intravenous agents for general anaesthesia. From chemical point of view these compounds belong to structurally diverse categories, such as barbiturates − thiopental (Sodium pentothal®, Trapanal®, Pentothal®), methohexital (Brevital®), and hexobarbital (Evipan®, Hexenal®, Citopan®, Tobinal®); non-barbiturate derivatives − ketamine (Ketalar® Ketaset®), esketamine (Ketanest®), and etomidate (Amidate®, Hypnomidate®), phenolic derivatives − propofol (Diprivan®); steroid derivatives – mixture of alfadolone and alfaxalone (Althesin® in human and Saffan® in veterinary anesthesia); and derivatives of phenylacetic acid − propanidid (Epontol®, Sombrevin®). Most of these compounds are chiral, with the exception of propofol and propanidid. Apart from etomidate and esketamine, they are used in the form of their racemates. Besides their characteristics and mechanism of action, attention is centred also on their chiral properties.
- MeSH
- Anesthetics, General pharmacokinetics pharmacology MeSH
- Anesthetics, Intravenous * pharmacokinetics pharmacology MeSH
- Humans MeSH
- Stereoisomerism MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- MeSH
- Anesthetics, Intravenous MeSH
- Anesthesia * MeSH
- Diet, Ketogenic * MeSH
- Humans MeSH
- Evoked Potentials, Motor physiology MeSH
- Scoliosis * surgery MeSH
- Check Tag
- Humans MeSH
- Publication type
- Letter MeSH
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
Ketamine exerts anti-inflammatory, neuroprotective and neuroplastic activity, therefore it may counteract the neurotoxic processes underlying postoperative delirium. However, the majority of studies in this field failed. We identified several pharmacological reasons why these studies may have failed, together with suggestions of how to remediate them. Among them, the interaction with intravenous general anesthetics exerting the opposite effect on GABA interneurons than ketamine may be of principal importance. We suggest biomarkers which may elucidate the influence of this interaction on the different steps of neuroplastic pathways. We hypothesize that administering ketamine before or after general anesthesia could both prevent the interactions and strengthen the effect of ketamine by timing surgery within the climax of ketamine-induced neuroplastic changes or by stabilizing AMPA receptors. It is vital to deal with these questions because the protocols of ongoing studies are based again on the administration of ketamine during general anesthesia (the major identified pitfall).
V celé Evropě se rozmáhá okrádání řidičů kamionů nebo lidí v obytných přívěsech po předchozím uspání. Také v Německu došlo v lednu 2022 k loupeži součástek kol v hodnotě 250 milionů korun na odpočívadle pro kamiony. Hlavní roli měl hrát „uspávací plyn“. Článek podává přehled o základních farmakologických účincích látek, které by přicházely v úvahu. Jsou to oxid uhličitý, oxid uhelnatý, oxid dusný, stará inhalační anestetika dietyléter a chloroform a nová inhalační anestetika isofluran, sevofluran, desfluran a v poslední době znovu používaný metoxyfluran. Z analýzy vyplývá, že žádná z těchto látek nepřichází v úvahu a že se patrně jedná o tzv. městskou legendu. Neexistuje dosud žádný případ, v němž by bylo prokázáno použití uspávacího plynu. Při osvobozování rukojmích v moskevském divadle na Dubrovce v říjnu 2002 použily speciální jednotky ruské armády aerosolovou směs remifentanilu s carfentanilem s nosným plynem – inhalačním anestetikem halotanem. Z počtu 830 rukojmích zahynulo vlivem tohoto uspávacího plynu přibližně 130 osob. Řidiči však mohou být omámeni a následně okradeni po podání četných farmak, která spadají do kategorie tzv. rape drugs.
The robbery of truck drivers or caravaners after being put under is rising across Europe. In January 2022, bicycle parts worth 250 million were robbed at a truck stop in Germany. The central role was attributed to the so-called sleeping gas. The article provides an overview of the fundamental pharmacological effects of the substances that could be considered. These are carbon dioxide, carbon monoxide, nitrous oxide, diethyl ether and chloroform, the old, inhaled anesthetics, as well as isoflurane, sevoflurane, desflurane and the recently re-used methoxyflurane as the new inhaled anesthetics. The analysis shows that none of these substances is the possible cause, and it is probably an urban legend. The use of a sleeping gas has not been demonstrated in any case yet. During the release of hostages in the Dubrovka theatre in Moscow in October 2002, special units of the Russian army used an aerosol mixture of remifentanil and carfentanil with a carrier gas – halothane, an inhalation anesthetic. Out of 830 hostages, about 130 died from this sleeping gas. However, drivers may be drugged and subsequently robbed after administering numerous drugs that fall into the category of rape drugs.
- MeSH
- Anesthetics, Inhalation * chemistry history therapeutic use MeSH
- Chloroform history MeSH
- Humans MeSH
- Naphthoquinones history therapeutic use MeSH
- Nitrous Oxide history therapeutic use MeSH
- Carbon Monoxide chemistry MeSH
- Carbon Dioxide history poisoning adverse effects therapeutic use MeSH
- Specialty Uses of Chemicals MeSH
- Terrorism MeSH
- Crime MeSH
- Check Tag
- Humans MeSH
Rok 2022 se publikačně již plně vrátil do standardu. To především znamená, že pro anesteziology je celosvětová pandemie viru SARS‐CoV- 2 již zapomenuta, a dominantním tématem je opět bezpečnost anestezie. K tradičnímu hledání odpovědí na otázky, jestli bychom měli spíše preferovat regionální nebo celkovou anestezii a u jakých výkonů, a jaká je nejlepší prevence PONV, se ale nově přidává další s tím spojené téma – pooperační delirium a pooperační kognitivní dysfunkce. Přestože obě tyto entity mají na celkový perioperační průběh zcela zásadní význam, stále jim není věnována dostatečná pozornost. A to přestože především u starších pacientů je již prokázáno, že ovlivňují významně perioperační morbiditu i mortalitu. A k překvapení mnohých recentní data ukazují, že jejich výskyt není zdaleka tak závislý na typu anestezie, jako na kvalitě jejího provedení. Cílem tohoto textu je ve zkratce shrnout některé klíčové publikace v oblasti anesteziologie, a upozornit na práce, které by neměly uniknout pozornosti.
By 2022, publishing has already returned to the standard. This means that the global SARS-CoV-2 pandemic for anaesthesiologists is all but forgotten, and the safety of anesthesia is again the dominant issue. However, in addition to the traditional search for answers to whether we should prefer regional or general anesthesia and for which procedures and what is the best prevention of PONV, there is now another associated topic - postoperative delirium and postoperative cognitive dysfunction. Although both entities are crucial to the overall perioperative course, they still need more attention. This is even though, especially in elderly patients, they have already been shown to significantly affect perioperative morbidity and mortality. Moreover, to the surprise of many, recent data show that their incidence is not so much dependent on the type of anesthesia but on the quality of its administration. This text aims to briefly summarize some key publications in the field of anesthesiology and to highlight papers that should not escape attention.
