静脉麻醉PPT参考课件.pptVIP

* Problems and Controversies with TCI Systems. There are some important unsolved problems, limitations, and controversies surrounding TCI systems. The most obvious limitation is that TCI systems can only be as good as the pharmacokinetic model with which they are programmed. It is clear that some pharmacokinetic parameter sets for a given drug perform better than others when used to deliver a drug by computer. Which pharmacokinetic model parameter sets perform best and why is an area of intense investigation.12 Other TCI controversies relate to the problem of plasma effect site dysequilibrium. This is an important issue in that the effect site, or “biophase” concentrations, not the plasma concentrations, best correlate with drug effect. Although the plasma has been the target site for most early TCI applications, the effect site is the more logical target.13,14 When targeting the plasma concentration, there is a significant delay in the achievement of a stable level of drug effect for many drugs; targeting the effect site results in faster attainment of therapeutic concentrations in the biophase, although this advantage may be associated with a slightly greater incidence of adverse events (e.g., hypotension).13 Another unresolved problem associated with TCI is the search for an adequate method to define and describe appropriate IV anesthetic concentration targets (i.e., a “MAC” equivalent for IV drugs). Intravenous anesthetic pharmacodynamics have traditionally been characterized in terms of a CP50, the steady-state plasma concentration required to produce a 50% probability of some specified effect. However, it is somewhat difficult to apply this information to the selection of an appropriate TCI target, because the methods used to identify these CP50s have not been fully standardized as with MAC (some CP50s relate to loss of consciousness, others to movement and hemodynamics; some are estimated in the presence of other drugs, etc.). How IV anesthetic CP50s esti