title: Predictive performance of a physiological model for enflurane closed-circuit anaesthesia: effects of continuous cardiac output measurements and age-related solubility data.
abstract: BACKGROUND
  The disposition of inhalation anaesthetics is governed by the factors described in the Fick principle.
  
  
  METHODS
  We have recalibrated a previously validated physiological model for enflurane closed-circuit inhalation anaesthesia, using individual continuous cardiac output measurements as well as age-related enflurane solubility coefficients as inputs to the model. Two model versions using 'calculated' (Brody's formula) or 'measured' (thoracic electrical bioimpedance) cardiac output values, and two versions with 'standard' (fixed) or 'age-related' solubility coefficients were formulated.
  
  
  RESULTS
  Data from 62 ophthalmic surgical patients were used to validate the predictive performance of the four model versions. The root mean squared errors (total error) and scatters (error variation) were similar with the extended model versions, but the group biases (systematic error component) were significantly less with the model versions that included age-related solubility compared with the versions using standard solubility coefficients (bias -0.76/-0.78% vs -3.44/-3.60%).
  
  
  CONCLUSIONS
  The inclusion of age-related solubility coefficients but not of continuous cardiac output measurements improves the predictive performance of the physiological model for closed-circuit inhalation anaesthetic conditions in routine clinical practice.
authors.affiliation: Division of Peri-operative Care, Anaesthesia and Pain Medicine, University Medical Centre Utrecht (UMCU), The Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: Vermeulen
authors.forename: C J
authors.initials: CJ
authors.lastname: Kalkman
authors.forename: R
authors.initials: R
authors.lastname: Dirksen
authors.forename: J T A
authors.initials: JT
authors.lastname: Knape
authors.forename: K G M
authors.initials: KG
authors.lastname: Moons
authors.forename: G F
authors.initials: GF
authors.lastname: Borm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D000764:Anesthesia, Closed-Circuit / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000737:chemistry / Q000493:pharmacokinetics*; D000886:Anthropometry; D002302:Cardiac Output / Q000502:physiology*; D004737:Enflurane / Q000737:chemistry / Q000493:pharmacokinetics*; D006801:Humans; D008875:Middle Aged; D008954:Models, Biological; D013508:Ophthalmologic Surgical Procedures; D012995:Solubility
chemical_list: D018685:Anesthetics, Inhalation; D004737:Enflurane