Simulation of propofol anaesthesia for intracranial decompression using brain hypothermia treatment

Lu Gaohua,Hidenori Kimura

doi:10.1186/1742-4682-4-46

Abstract

BackgroundAlthough propofol is commonly used for general anaesthesia of normothermic patients in clinical practice, little information is available in the literature regarding the use of propofol anaesthesia for intracranial decompression using brain hypothermia treatment. A novel propofol anaesthesia scheme is proposed that should promote such clinical application and improve understanding of the principles of using propofol anaesthesia for hypothermic intracranial decompression.MethodsTheoretical analysis was carried out using a previously-developed integrative model of the thermoregulatory, hemodynamic and pharmacokinetic subsystems. Propofol kinetics is described using a framework similar to that of this model and combined with the thermoregulation subsystem through the pharmacodynamic relationship between the blood propofol concentration and the thermoregulatory threshold. A propofol anaesthesia scheme for hypothermic intracranial decompression was simulated using the integrative model.ResultsCompared to the empirical anaesthesia scheme, the proposed anaesthesia scheme can reduce the required propofol dosage by more than 18%.ConclusionThe integrative model of the thermoregulatory, hemodynamic and pharmacokinetic subsystems is effective in analyzing the use of propofol anaesthesia for hypothermic intracranial decompression. This propofol infusion scheme appears to be more appropriate for clinical application than the empirical one.

Highlights

Propofol is commonly used for general anaesthesia of normothermic patients in clinical practice, little information is available in the literature regarding the use of propofol anaesthesia for intracranial decompression using brain hypothermia treatment
Propofol is widely used in clinical practice for brain hypothermia treatment [4]
The concentration at 30 min was 2.1% of the blood concentration. These results show that the cerebrospinal fluid (CSF) propofol concentration is positively correlated with, and much lower than, the blood propofol concentration

Summary

Introduction

Propofol is commonly used for general anaesthesia of normothermic patients in clinical practice, little information is available in the literature regarding the use of propofol anaesthesia for intracranial decompression using brain hypothermia treatment. Achieving a sustained reduction in ICP in patients with intracranial hypertension remains a great challenge in clinical practice. Brain hypothermia treatment has been demonstrated to be especially effective for patients with refractory intracranial hypertension, for whom conventional therapeutic options for decompression have failed [2]. About half of hypothermia treatments were introduced for the purpose of controlling refractory intracranial hypertension [3]. Besides the management of intracranial temperature and pressure, the administration of anaesthesia is another important task in therapeutic hypothermia treatment. Propofol is widely used in clinical practice for brain hypothermia treatment [4]. The rates of propofol administration are based mainly on clinical experience (page number not for citation purposes)

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Results

Discussion

Conclusion