Desempeño predictivo y clínico de un dispositivo target-controlled infusion para sevofluorano en una estación de trabajo convencional: correlación farmacocinética del modelo empleado

Abstract

IntroductionGood governance of resources and global warming has attracted interest on minimal flow (0.3–0.5 l/min) inhalation anesthesia. ObjectivesTo evaluate the predictive and clinical performance of a TCI (Target-controlled infusion) device, and its pharmacokinetic correlation for sevoflurane. MethodsProspective, longitudinal, and analytical study on 25 adult patients. Fresh gas flow used 0.5 l/min. Target concentration of 1.2% (v/v). Continuous and variable infusion into the circuit of the anesthesia workstation. Controller developed with LABVIEW 6.1. Hemodynamic, respiratory and anesthetic depth data collected every 5 s using the anesthesia workstation software. Bias (MDPE%), inaccuracy (MDAPE%), wobble, and divergence of the TCI device were determined in the first hour. STATA-12 pk collapse was used to analyze the area under the curve of the target and expired concentrations. The results are expressed as Mean (CI 95%) and Median [IQR]*. ResultsTarget concentration used 1.22 [1.14–1.37] %*, reached in 04:07 [03:15–06:15]* min:s (expiratory branch). Anesthetic duration 1:10:50 (00:56:57–1:24: 43) h:min:s. Sevoflurane consumption 6.9 (5.7–8.0) ml. MDPE% −12.8 (−17.6 to −8.1) %; MDAPE% 15.9 (11.9–19.8) %; wobble 6.9 (5.0–8.7)% and divergence 0.89% (−5.96 to 7.7)%h-1. Interactions per hour on the TCI of 3 (2–4). Correlation of the area under the curve, Spearman's rho = 0.8577, p < 0.00001. ≥15% inaccuracy was associated with age >65 years and obesity. ConclusionsThe TCI sevoflurane© showed good performance, and the target concentration was rapidly reached and remained stable, with few interactions with the device needed during the first hour. There were neither overdosing nor clinically significant alterations.