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.

• Klíčová slova
• Mathematical modeling in anesthesia, Pharmacokinetics, Propofol, Target-controlled infusion,
• MeSH
• anestetika intravenózní * aplikace a dávkování   farmakokinetika   farmakologie   MeSH
• biologické modely MeSH
• intravenózní infuze MeSH
• lidé MeSH
• propofol * aplikace a dávkování   farmakokinetika   farmakologie   MeSH
• strojové učení MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH
• Názvy látek
• anestetika intravenózní * MeSH
• propofol * MeSH

BACKGROUND: Hypotension after induction of general anesthesia (GAIH) is common in anesthesiology practice and can impact outcomes. METHODS: In this prospective multicenter, cross-sectional, observational study, the hypotension was defined as a decrease in mean arterial pressure of > 30% compared to the first measurement in the operation theatre before general anesthesia (GA) induction. Blood pressure was measured immediately at the time of endotracheal intubation (TETI), at five (T5) and 10 (T10) minutes after. All subjects aged > 18 years undergoing elective non-cardiac surgery under GA were included. The goals were description of GAIH occurrence, the association of GAIH with selected comorbidities, chronic medications, and anesthetics with GAIH, and the type and efficacy of interventions used to correct hypotension. RESULTS: Data from 661 subjects, whose GA was induced with propofol and sufentanil, were analyzed. In 36.5% of subjects, GAIH was observed at ≥ 1 of the assessed time points. GAIH was present in 2.9% subjects at all time points. The probability of GAIH is raising with age, degree of hypertension at time of arrival to theatre and presence of diabetes. The type of volatile anesthetic was not associated with the occurrence of GAIH. The overall efficiency of interventions to correct hypotension was 94.4%. Bolus fluids were the most often used intervention and was 96.4% effective. CONCLUSION: GAIH rate depends on age, degree of blood pressure decompensation prior the surgery, and presence of diabetes mellitus type II.

• Klíčová slova
• Anesthesia induction, General anesthesia, Hypotension, Predictors, Risk factors,
• MeSH
• anestetika intravenózní aplikace a dávkování   škodlivé účinky   MeSH
• arteriální tlak účinky léků   MeSH
• celková anestezie škodlivé účinky   metody   MeSH
• dospělí MeSH
• hypertenze epidemiologie   MeSH
• hypotenze epidemiologie   MeSH
• intratracheální intubace MeSH
• krevní tlak účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření krevního tlaku MeSH
• propofol aplikace a dávkování   farmakologie   MeSH
• prospektivní studie MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• sufentanil aplikace a dávkování   farmakologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Názvy látek
• anestetika intravenózní MeSH
• propofol MeSH
• sufentanil MeSH

WHAT IS KNOWN AND OBJECTIVE: Drug-induced acute pancreatitis comprises only 0.5%-2% of all cases of acute pancreatitis. Propofol is a potentially dangerous drug that can cause acute pancreatitis, but this complication is extremely rare. CASE SUMMARY: A 57-year-old patient developed acute pancreatitis after a planned thyroidectomy. As the common causes of acute pancreatitis were excluded, we believe that the pancreatitis was drug-induced, in this case by a single dose of propofol administered to the patient during the surgery. WHAT IS NEW AND CONCLUSION: We present a rare case of propofol-induced acute necrotising pancreatitis, which is to the best of our knowledge the first fatal case reported in an adult patient.

• Klíčová slova
• adverse drug reaction, drug-induced acute pancreatitis, propofol,
• MeSH
• akutní nekrotizující pankreatitida chemicky indukované   MeSH
• anestetika intravenózní aplikace a dávkování   škodlivé účinky   MeSH
• fatální výsledek MeSH
• lidé středního věku MeSH
• lidé MeSH
• propofol aplikace a dávkování   škodlivé účinky   MeSH
• tyreoidektomie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• anestetika intravenózní MeSH
• propofol MeSH

BACKGROUND: Combined infusions of propofol and sufentanil preparations are frequently used in clinical practice to induce anesthesia and analgesia. However, the stability of propofol emulsions can be affected by dilution with another preparation, sometimes leading to particle coalescence and enlargement. Such unwanted effects can lead to fat embolism syndrome after intravenous application. This study describes the physical stability of 5 commercially available propofol preparations mixed with sufentanil citrate solutions. METHODS: Two common markers of emulsion stability were used in this study; namely, the zeta potential and size distribution of the emulsion droplets. Both were measured using dynamic light scattering. The data for the pure propofol preparations and their mixtures with sufentanil citrate solution were compared. RESULTS: The absolute value of zeta potential decreased in 4 of the 5 propofol preparations after they had been mixed with sufentanil citrate. This effect indicates a lowering of repulsive interactions between the emulsion droplets. Although this phenomenon tends to cause agglomeration, none of the studied mixtures displayed a substantial increase in droplet size within 24 hours of blending. However, our long-term stability study revealed the instability of some of the propofol-sufentanil samples. Two of the 5 studied mixtures displayed a continual increase in particle size. The same 2 preparations showed the greatest reductions in the absolute value of zeta potential, thereby confirming the correlation of both measurement methods. The increase in particle size was more distinct in the samples stored at higher temperatures and with higher sufentanil concentrations. CONCLUSIONS: To ensure the microbial stability of an emulsion infusion preparation, clinical regulations require that such preparations should be applied to patients within 12 hours of opening. In this respect, we can confirm that during this period, none of the studied propofol-sufentanil mixtures displayed any physical instability that could lead to particle enlargement; thus, fat embolism should not be a risk after their intravenous application. However, our long-term stability study revealed differences between commercially available preparations containing the same active ingredient; some of the mixtures showed an increase in particle size and polydispersity over a longer period. Although our results should not be generalized beyond the particular propofol-sufentanil preparations and concentrations studied here, they do suggest that, as a general principle, a compatibility study should be performed for any preparation before the first intravenous application to exclude the risk of droplet aggregation.

• MeSH
• anestetika intravenózní aplikace a dávkování   chemie   MeSH
• chemické jevy * MeSH
• fixní kombinace léků MeSH
• intravenózní infuze MeSH
• lidé MeSH
• propofol aplikace a dávkování   chemie   MeSH
• stabilita léku MeSH
• sufentanil aplikace a dávkování   chemie   MeSH
• velikost částic MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• anestetika intravenózní MeSH
• fixní kombinace léků MeSH
• propofol MeSH
• sufentanil MeSH

The present study evaluated whether drug-induced sleep endoscopy (DISE) helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA). A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP) treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%). The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse (n = 17, 33.3%), followed by palatal and oropharyngeal collapse (n = 12, 23.5%). Pathology of the larynx (epiglottis) was observed in 16 patients (31.4%). The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3%) patients. After DISE, the surgical plan was changed in 31 patients (60.8%). The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA.

• MeSH
• anestetika intravenózní aplikace a dávkování   MeSH
• anestetika lokální MeSH
• dospělí MeSH
• endoskopie metody   MeSH
• epiglotis patofyziologie   MeSH
• jazyk chirurgie   MeSH
• larynx patologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• obstrukce dýchacích cest patofyziologie   MeSH
• obstrukční spánková apnoe terapie   MeSH
• orofarynx patofyziologie   MeSH
• otorinolaryngologie MeSH
• polysomnografie metody   MeSH
• propofol aplikace a dávkování   MeSH
• prospektivní studie MeSH
• spánek MeSH
• trvalý přetlak v dýchacích cestách MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• anestetika intravenózní MeSH
• anestetika lokální MeSH
• propofol MeSH

OBJECTIVE/BACKGROUND: Obstructive sleep apnea (OSA) is highly prevalent and often undiagnosed in surgical patients. The aim of this study was to compare polygraphy (PG) performed on sedated patients during surgery to overnight polysomnography (PSG). It was hypothesized that perioperative PG may be used to diagnose OSA. PATIENTS/METHODS: Overnight PSG was performed three days prior to surgery. For surgery, spinal anesthesia and sedation with propofol infusion were used. Sedation depth was monitored by the Bispectral index and maintained for all patients (target level 75). Echocardiography studies were available in three patients, and all were diagnosed with diastolic dysfunction. Relatively high prevalence of CSA in patients with diastolic dysfunction has been previously reported. During surgery, PG recording (Embletta) was performed. Sleep apnea was defined by the type (central/obstructive apnea ≥50%) and by the apnea-hypopnea index (AHI) (events/hour: AHI < 5 no apnea; 5 ≤ AHI < 15 mild apnea; 15 ≤ AHI < 30 moderate apnea; AHI ≥30 severe apnea). Bland-Altman plots were used for analysis, and 2 × 2 decision statistics were calculated for several cut-off values of the AHI. Data were shown as bias with limits of agreement (bias±1.96 standard deviations). RESULTS: Nineteen subjects were studied: nine (47%) were diagnosed with obstructive, seven (37%) with central sleep apnea, and three (16%) with no sleep apnea by overnight PSG. Perioperative PG bias was 12 (-37; 61) for AHI; 6 (-25; 37) for obstructive apnea; 0 (-4; 4) for central apnea, and 6 (-31; 43) for hypopnea. For the detection of OSA, a PG cut-off value of AHI 5 yielded 89% sensitivity and 60% specificity, AHI 15 yielded 86% sensitivity and 67% specificity, and AHI 30 yielded 100% sensitivity and 71% specificity. CONCLUSION: Wide limits of agreement preclude perioperative PG to be used as a diagnostic method; however, it may be useful to screen sedated surgical patients for OSA.

• Klíčová slova
• Obstructive sleep apnea, Screening, Sedation, Sleep-disordered breathing,
• MeSH
• ambulantní monitorování přístrojové vybavení   MeSH
• epidurální anestezie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• obstrukční spánková apnoe diagnóza   epidemiologie   patofyziologie   MeSH
• perioperační období MeSH
• plošný screening přístrojové vybavení   MeSH
• polysomnografie metody   MeSH
• prevalence MeSH
• propofol aplikace a dávkování   MeSH
• senioři MeSH
• spánek fyziologie   MeSH
• spánková apnoe centrální diagnóza   epidemiologie   MeSH
• totální endoprotéza kolene metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Názvy látek
• propofol MeSH

BACKGROUND: Following opioid and intravenous anaesthetic, tracheal intubation may be accomplished without any muscle relaxant. In this study, we evaluated the dose requirements for sufentanil with propofol without muscle relaxant administration to obtain clinically acceptable intubation conditions and cardiovascular responses. METHODS AND RESULTS: After midazolam (0.05 mg x kg(-1)), 90 patients were randomized into three equal groups, each receiving sufentanil 0.2 (SUF-0.2), 0.3 (SUF-0.3) or 0.4 (SUF-0.4) microg x kg(-1), respectively. Following induction of anaesthesia with propofol (2 mg x kg(-1)), the quality of tracheal intubation was assessed as excellent or good (clinically acceptable) and poor. Excellent intubation conditions were observed in 28%, 41% and 54% of patients in groups SUF-0.2, SUF-0.3 and SUF-0.4, respectively, while poor conditions were present in 31% (SUF-0.2; p = 0.041 vs. SUF-0.3, p = 0.006 vs SUF-0.4), 7% (SUF-0.3) and 3% (SUF-0.4). Patients with induction-related hypotension were older than those without (60 +/- 15 vs. 52 +/- 17 yr, p = 0.013). CONCLUSIONS: Sufentanil (0.3-0.4 microg x kg(-1)) in combination with propofol (2 mg.kg(-1)) provided clinically acceptable intubating conditions in 93-97% patients.

• MeSH
• anestetika intravenózní aplikace a dávkování   MeSH
• celková anestezie * MeSH
• hemodynamika MeSH
• intratracheální intubace * MeSH
• lidé středního věku MeSH
• lidé MeSH
• nervosvalové blokátory aplikace a dávkování   MeSH
• propofol aplikace a dávkování   MeSH
• sufentanil aplikace a dávkování   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• anestetika intravenózní MeSH
• nervosvalové blokátory MeSH
• propofol MeSH
• sufentanil MeSH