The Value of Real Time Pharmacokinetic and Pharmacodynamic Modeling in Critical Care

The Value of Real Time Pharmacokinetic and

Pharmacodynamic Modeling in Critical Care

Pharmacodynamic Modeling(V1)Central Compartment

(V2)Rapid Peripheral Compartment

(V3)Slow

Peripheral Compartment

(Ve) Effect Site

Infusion Pumps

Bar-codedBolus

Syringes

PharmacokineticModels

Drug delivery devices

Syroid N, Anesth 2002;96:565-575

[remi] (ng/ml) [prop] (ug/ml)

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(a)

184.816.4

199.884.816.4

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84.816.4199.8

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RPRP

RPRP

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Effect

[remi] (ng/ml)

[prop] (ug/ml)

(b)

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(c)

[prop] (ug/ml)

[remi] (ng/ml)

[prop] (ug/ml)

[remi] (ng/ml)

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(d)

Return of Responsiveness

Laryngoscopy

Mertens and Kern

Effect Path

Figure 2 –

Analgesia Level (Control)

Analgesia Level (Display)

Skin Incisions

Artho-scopic Procedure

Bankart Procedure

Maintenance Phase Time (min).

0 10 20

Level of Pain/Analgesia

Experiment 1: ResultsHeart Rate

Bankhart Procedure

52

54

56

58

60

62

64

66

hr

bp

m controlDD

*

Experiment 1: ResultsBlood Pressure

Bankhart Procedure

74767880828486889092

bp

mm

Hg

controlDD

*

0

1

2

3

4

5

6

7

8

9

10

Perf

orm

ance

Fru

str

atio

n L

eve

l

Effort

Menta

l Dem

and

Phys

ical D

em

and

Tem

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Without Drug Display With Drug Display

*

*

**

Anesthesia Advisory Display: Real time guidance through the pharmacokinetic and interaction pharmacodynamic relationship during simultaneous administration of multiple drugs.Schumacher, Bouillon, Leibundgut, Sartori, Zbinden, ASA 2004

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