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Effect of Hemodynamic Changes in Plasma Propofol Concentrations Associated with Knee-Chest Position in Spinal Surgery: A Prospective Study

2019-10Journal article Open access
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dc.contributor.authorChalo, D.
dc.contributor.authorPedrosa, S.
dc.contributor.authorAmorim, Pedro
dc.contributor.authorSilva, A.
dc.contributor.authorGuedes de Pinho, P.
dc.contributor.authorCorreia, R.
dc.contributor.authorGouveia, S.
dc.contributor.authorSancho, C.
dc.date.accessioned2020-04-16T14:30:12Z
dc.date.available2020-04-16T14:30:12Z
dc.date.issued2019-10
dc.description.abstractBackground: Anesthesia induction and maintenance with propofol can be guided by target-controlled infusion (TCI) systems using pharmacokinetic (Pk) models. Physiological variables, such as changes in cardiac output (CO), can influence propofol pharmacokinetics. Knee-chest (KC) surgical positioning can result in CO changes. Objectives: This study aimed to evaluate the relationship between propofol plasma concentration prediction and CO changes after induction and KC positioning. Methods: This two-phase prospective cohort study included 20 patients scheduled for spinal surgery. Two different TCI anesthesia protocols were administered after induction. In phase I (n = 9), the loss of consciousness (LOC) concentration was set as the propofol target concentration and CO changes following induction and KC positioning were quantified. In phase II (n = 11), based on data from phase I, two reductions in the propofol target concentration on the pump were applied after LOC and before KC positioning. Propofol plasma concentrations were measured at different moments in both phases: after induction and after KC positioning. Results: Schnider Pk model showed a good performance in predicting propofol concentration after induction; however, after KC positioning, when a significant drop in CO occurred, the measured propofol concentrations were markedly underestimated. Intended reductions in the propofol target concentration did not attenuate HD changes. In the KC position, there was no correlation between the propofol concentration estimated by the Pk model and the measured concentration in plasma, as the latter was much higher (P = 0.013) while CO and BIS decreased significantly (P < 0.001 and P = 0.004, respectively). Conclusions: Our study showed that the measured propofol plasma concentrations during the KC position were significantly underestimated by the Schnider Pk model and were associated with significant CO decrease. When placing patients in the KC position, anesthesiologists must be aware of pharmacokinetic changes and, in addition to standard monitoring, the use of depth of anesthesia and cardiac output monitors may be considered in high-risk patients.pt_PT
dc.description.sponsorshipThis work was partially funded by the Foundation for Science and Technology, FCT, through national (MEC) and European structural (FEDER) funds, in the scope of the research projects UID/MAT/04106/2019 (CIDMA/UA), UID/CEC/00127/2019 (IEETA/UA) and UID/MAT/00144/2019 (CMUP/UP). This work was also partially suported by Portugal 2020 under the Competitiveness and Internationalization Operational Program, and by the European Regional Development Fund through project SOCA-Smart Open Campus (CENTRO-01-0145-FEDER-000010), acknowledgements from Sonia Gouveia. Aura Silva also acknowledges the postdoctoral grant by FCT (ref. SFRH/BPD/75697/2011).pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationChalo D, Pedrosa S, Amorim P, et al. Effect of Hemodynamic Changes in Plasma Propofol Concentrations Associated with Knee-Chest Position in Spinal Surgery: A Prospective Study. Anesth Pain Med. 2019;9(5):e96829. Published 2019 Sep 24. doi:10.5812/aapm.96829pt_PT
dc.identifier.doi10.5812/aapm.96829pt_PT
dc.identifier.issn2228-7523
dc.identifier.issn2228-7531
dc.identifier.urihttp://hdl.handle.net/10400.16/2353
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherKowsarpt_PT
dc.relation.publisherversionhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925539/pt_PT
dc.subjectAnesthesiapt_PT
dc.subjectHemodynamicspt_PT
dc.subjectInfusion Pumpspt_PT
dc.subjectKnee-Chest Positionpt_PT
dc.subjectPropofol Pharmacokineticspt_PT
dc.titleEffect of Hemodynamic Changes in Plasma Propofol Concentrations Associated with Knee-Chest Position in Spinal Surgery: A Prospective Studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/SFRH/SFRH%2FBPD%2F75697%2F2011/PT
oaire.citation.conferencePlaceNetherlandspt_PT
oaire.citation.issue5pt_PT
oaire.citation.startPagee96829pt_PT
oaire.citation.titleAnesthesiology and pain medicinept_PT
oaire.citation.volume9pt_PT
oaire.fundingStreamSFRH
person.familyNameAmorim
person.givenNamePedro
person.identifier.orcid0000-0001-7466-4174
person.identifier.scopus-author-id55429654100
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublicationaad38f74-e8d1-431c-a230-8ca77db9f190
relation.isAuthorOfPublication.latestForDiscoveryaad38f74-e8d1-431c-a230-8ca77db9f190
relation.isProjectOfPublication6b396b57-c35a-4759-a848-cca649755032
relation.isProjectOfPublication.latestForDiscovery6b396b57-c35a-4759-a848-cca649755032

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