Mechanism-based pharmacodynamic model for propofol haemodynamic effects in healthy volunteers☆

Hong Su,Douglas J Eleveld,Michel M.R.F Struys,Pieter J Colin

doi:10.1016/j.bja.2022.01.022

Hong Su, Douglas J Eleveld + Show 2 more

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https://doi.org/10.1016/j.bja.2022.01.022

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Abstract

BackgroundThe adverse haemodynamic effects of the intravenous anaesthetic propofol are well known, yet few empirical models have explored the dose–response relationship. Evidence suggests that hypotension during general anaesthesia is associated with postoperative mortality. We developed a mechanism-based model that quantitatively characterises the magnitude of propofol-induced haemodynamic effects during general anaesthesia. MethodsMean arterial pressure (MAP), heart rate (HR) and pulse pressure (PP) measurements were available from 36 healthy volunteers who received propofol in a step-up and step-down fashion by target-controlled infusion using the Schnider pharmacokinetic model. A mechanistic pharmacodynamic model was explored based on the Snelder model. To benchmark the performance of this model, we developed empirical models for MAP, HR, and PP. ResultsThe mechanistic model consisted of three turnover equations representing total peripheral resistance (TPR), stroke volume (SV), and HR. Propofol-induced changes were implemented by Emax models on the zero-order production rates of the turnover equations for TPR and SV. The estimated 50% effective concentrations for propofol-induced changes in TPR and SV were 2.96 and 0.34 μg ml−1, respectively. The goodness-of-fit for the mechanism-based model was indistinguishable from the empirical models. Simulations showed that predictions from the mechanism-based model were similar to previously published MAP and HR observations. ConclusionsWe developed a mechanism-based pharmacodynamic model for propofol-induced changes in MAP, TPR, SV, and HR as a potential approach for predicting haemodynamic alterations. Clinical trial registrationNCT02043938

Highlights

The adverse haemodynamic effects of the intravenous anaesthetic propofol are well known, yet few empirical models have explored the doseeresponse relationship
As Mean arterial pressure (MAP) and heart rate (HR) were elevated before propofol infusion, we explored whether including a time-dependent effect in the models could improve the goodness-of-fit
MAP, HR, and pulse pressure (PP) observations used for modelling are shown in Online Supplementary 4, Figs 4e1, which shows that MAP decreases in the step-up phase, increases in the stepdown phase and decreases again around the time of the bolus

Summary

Introduction

The adverse haemodynamic effects of the intravenous anaesthetic propofol are well known, yet few empirical models have explored the doseeresponse relationship. We developed a mechanism-based model that quantitatively characterises the magnitude of propofol-induced haemodynamic effects during general anaesthesia. A mechanistic pharmacodynamic model was explored based on the Snelder model. To benchmark the performance of this model, we developed empirical models for MAP, HR, and PP. Propofol-induced changes were implemented by Emax models on the zero-order production rates of the turnover equations for TPR and SV. The goodness-of-fit for the mechanism-based model was indistinguishable from the empirical models. Simulations showed that predictions from the mechanism-based model were similar to previously published MAP and HR observations. Conclusions: We developed a mechanism-based pharmacodynamic model for propofol-induced changes in MAP, TPR, SV, and HR as a potential approach for predicting haemodynamic alterations.

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