title: Propofol Breath Monitoring as a Potential Tool to Improve the Prediction of Intraoperative Plasma Concentrations.
abstract: Monitoring of drug concentrations in breathing gas is routinely being used to individualize drug dosing for the inhalation anesthetics. For intravenous anesthetics however, no decisive evidence in favor of breath concentration monitoring has been presented up until now. At the same time, questions remain with respect to the performance of currently used plasma pharmacokinetic models implemented in target-controlled infusion systems. In this study, we investigate whether breath monitoring of propofol could improve the predictive performance of currently applied, target-controlled infusion models.
  
  
  
  Based on data from a healthy volunteer study, we developed an addition to the current state-of-the-art pharmacokinetic model for propofol, to accommodate breath concentration measurements. The potential of using this pharmacokinetic (PK) model in a Bayesian forecasting setting was studied using a simulation study. Finally, by introducing bispectral index monitor (BIS) measurements and the accompanying BIS models into our PK model, we investigated the relationship between BIS and predicted breath concentrations.
  
  
  
  We show that the current state-of-the-art pharmacokinetic model is easily extended to reliably describe propofol kinetics in exhaled breath. Furthermore, we show that the predictive performance of the a priori model is improved by Bayesian adaptation based on the measured breath concentrations, thereby allowing further treatment individualization and a more stringent control on the targeted plasma concentrations during general anesthesia. Finally, we demonstrated concordance between currently advocated BIS models, relying on predicted effect-site concentrations, and our new approach in which BIS measurements are derived from predicted breath concentrations.
authors.affiliation: Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Postbus 30 001, Groningen, 9700 RB, The Netherlands. P.J.Colin@umcg.nl.|Laboratory of Medical Biochemistry and Clinical Analysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium. P.J.Colin@umcg.nl.
authors.forename: Pieter
authors.initials: P
authors.lastname: Colin
authors.affiliation: Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Postbus 30 001, Groningen, 9700 RB, The Netherlands.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Eleveld
authors.affiliation: Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Postbus 30 001, Groningen, 9700 RB, The Netherlands.
authors.forename: Johannes P
authors.initials: JP
authors.lastname: van den Berg
authors.affiliation: Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Postbus 30 001, Groningen, 9700 RB, The Netherlands.
authors.forename: Hugo E M
authors.initials: HEM
authors.lastname: Vereecke
authors.affiliation: Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Postbus 30 001, Groningen, 9700 RB, The Netherlands.|Department of Anesthesia, Ghent University, Ghent, Belgium.
authors.forename: Michel M R F
authors.initials: MMRF
authors.lastname: Struys
authors.affiliation: Department of Anaesthesiology, Klinikum der Universität München, Munich, Germany.
authors.forename: Gustav
authors.initials: G
authors.lastname: Schelling
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
authors.forename: Christian C
authors.initials: CC
authors.lastname: Apfel
authors.affiliation: Department of Anaesthesiology, Klinikum der Universität München, Munich, Germany.
authors.forename: Cyrill
authors.initials: C
authors.lastname: Hornuss
mesh_terms: D000328:Adult; D018686:Anesthetics, Intravenous / Q000032:analysis / Q000493:pharmacokinetics*; D001499:Bayes Theorem; D045853:Exhalation; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008954:Models, Biological; D008991:Monitoring, Physiologic / Q000379:methods*; D015742:Propofol / Q000032:analysis / Q000493:pharmacokinetics*; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol