[Predictive capability of the TCI Diprifusor system in patients with terminal chronic renal insufficiency].
OBJECTIVE
To evaluate the predictive capability of a target-controlled infusion (TCI) system in patients with terminal chronic renal failure by comparing real drug concentrations with predicted concentrations.


METHODS
Forty ASA II-III patients undergoing kidney transplants were enrolled and grouped by age: group A 18-54 years old and group B 55-80 years old. Propofol was administered through the Diprifusor TCI system (Astra Zeneca) with the target concentration of propofol for induction set at 3 micrograms/mL for group A patients and 2.5 micrograms/mL for group B patients. Arterial blood samples were taken for analysis of drug concentrations at the following times: 2 and 5 minutes after starting the infusion; immediately after the incision; before and 5 minutes after increasing or decreasing the target concentration > 25%; before and 5 minutes after switching off the perfusion for surgery; upon eye opening; and 30 minutes after switching off the infusion pump. The predictive capability of the system was determined by performance error (PE). We calculated bias (%, median PE) and accuracy (%, median absolute PE).


RESULTS
Twenty group A and 20 group B patients were studied. The median PEs in groups A and B, respectively, were -3.45 (-20.3-28.4) and -1.1 (-19.7-15.4). Median absolute PEs were 21.2 (11.9-45.1) and 16.3 (11.5-27.4), respectively.


CONCLUSIONS
The results indicate that the predictive capability of the Diprifusor pharmacokinetic model is acceptable in patients with terminal kidney failure, given the minor bias of 10% to 20% and the degree of accuracy between 20% and 40%.
Servicio de Anestesiología, Reanimación y Clínica del Dolor, Fundación Puigvert (IUNA), C/Cartagena 340, 08025-Barcelona. 29285sst@comb.es
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Sabaté Tenas
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Soler Corbera
J M
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Queraltó Companyo
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Baxarias Gascón
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007260:Infusion Pumps; D007676:Kidney Failure, Chronic / Q000097:blood / Q000601:surgery*; D016030:Kidney Transplantation; D008875:Middle Aged; D008954:Models, Biological; D015742:Propofol / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D015203:Reproducibility of Results
D018686:Anesthetics, Intravenous; D015742:Propofol