Clinical application of intravenous anesthetic infusion with use of a pharmacokinetic-pharmacodynamic model in children

ABSTRACT

Recently, intravenous sedatives and analgesics are being commonly used in children because of the clinical need for increasing the non-operating room anesthesia and intraoperative neurophysiologic monitoring during surgery and environmental problems. Administration methods (single bolus, intermittent bolus, or continuous infusion) vary according to the clinical request. Continuous intravenous anesthesia based on the weight is still the most commonly used method for administration of intravenous drugs in children. With the newly developed statistical method and medical devices, target controlled infusion of intravenous anesthetics has become possible in pediatric anesthesia, in spite of the difficulty in obtaining the specific pharmacokinetic model using pharmacokinetic parameters. Nowadays, a pharmacokinetic-pharmacodynamic model for complete effect-site target controlled infusion is available for use in children. Several drugs are used for pediatric sedation, such as analgesics or anesthetics such as opioids (remifentanil, sufentanil or alfentanil), neuromuscular blocking agents or sedatives (midazolam, dexmedetomidine). All these drugs have been used in continuous infusion via various methods including target controlled infusion. Many studies have been carried out by researchers to use target controlled infusion for safe and efficient treatment in children according to the increase in clinical demand. Various pharmacokinetic-pharmacodynamic models for commonly used intravenous drugs will be reviewed, with a focus on children in this small discussion.