Real-Time Personalised Pharmacokinetic-Pharmacodynamic Modelling in Propofol Anesthesia through Bayesian Inference.

Abstract

Pharmacological models describe a patient's response to the administration of a medicinal drug based on parameters derived from population studies. However, considerable inter-patient variability exists, such that population models may underperform when used to predict the actual response of a specific individual. In applications which demand predictive accuracy-such as target-controlled infusion of anesthetic agents-modeling uncertainty may reduce system dependability and introduce clinical risk. Our work investigates the use of Bayesian inference, implemented through a particle filter algorithm, to refine a prior model of propofol pharmacokinetics-pharmacodynamics and estimate patient-specific parameters in real-time. We report here on an observational clinical study conducted on 40 adults undergoing general anesthesia, where we evaluated the performance of Bayesian inference-personalized models in forecasting forward trends of depth of anesthesia (Bispectral Index) measurements and compared it with that of a traditional population-based pharmacological model. Our results show a significant reduction in prediction error metrics for the patient-specific models. Our study demonstrates the viability and practical implementability of Bayesian inference as a tool for real-time intra-operative estimation of personalized pharmacological models in anesthesia applications.