Intravenous drug dose optimization and drug effect monitoring in anaesthesia

Marko Sahinovic

Intravenous drug dose optimization and drug effect monitoring in anaesthesia

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Dit proefschrift onderstreept het belang van het optimaliseren van de dosering van anesthetica en geeft een beschrijving van de middelen die de anesthesiologen hebben om dit doel te bereiken.

Twee belangrijke onderwerpen komen hierbij aan bod.

Ten eerste hebben we onderzocht wat de invloed is van hersentumoren in de frontale hersenkwab op de pharmacokinetiek (de manier waarop het lichaam medicatie verwerkt) en pharmacodynamiek (de invloed van medicatie op het lichaam) van propofol bij patiënten die hieraan geopereerd werden.
Op basis van ons onderzoek concluderen wij dat hersentumoren wel invloed hebben op de farmacokinetiek, maar niet op de farmacodynamiek van propofol.

Ten tweede hebben we beoordeeld hoe effectief verschillende hypnose en analgesie monitors (BIS, CVI, CI, CS) zijn als hulpmiddel bij het optimaliseren van een anesthetische dosis in de algemene populatie.
Uiteindelijk concluderen wij dat de huidige generatie hypnose en analgesie monitors anesthesiologen wel beter in staat stellen om de medicatie dosis te optimaliseren dan de huidige praktijk (standaard dosering schema’s en doseren op geleide van hemodynamische variabelen), maar dat ze nog steeds belangrijke tekortkomingen hebben.

Originele taal-2	English
Kwalificatie	Doctor of Philosophy
Toekennende instantie	Rijksuniversiteit Groningen
Begeleider(s)/adviseur	Absalom, Tony, Supervisor Struys, Michel, Supervisor Eleveld, Douglas, Co-supervisor
Datum van toekenning	31-mei-2017
Plaats van publicatie	[Groningen]
Uitgever	Rijksuniversiteit Groningen
Gedrukte ISBN's	978-90-367-9842-6
Elektronische ISBN's	978-90-367-9841-9
Status	Published - 2017

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Title and contentsFinal publisher's version, 722 KB
Chapter 1Final publisher's version, 1,58 MB
Chapter 2Final publisher's version, 4,1 MB
Chapter 3Final publisher's version, 7,27 MB
Chapter 4Final publisher's version, 2,95 MB
Chapter 5Final publisher's version, 3,58 MB
Chapter 6Final publisher's version, 2,52 MB
Chapter 7Final publisher's version, 1,23 MB
Chapter 8Final publisher's version, 1,24 MB
AppendicesFinal publisher's version, 950 KB
Complete thesisFinal publisher's version, 19,6 MB
PropositionsFinal publisher's version, 404 KB

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title = "Intravenous drug dose optimization and drug effect monitoring in anaesthesia",

abstract = "This thesis describes the importance of anesthetic drug dose optimization and the means that anesthetists have to achieve this. Two main subjects were addressed. First, the influence of frontal brain tumor on the pharmacokinetics (the study of how an organism affects a drug) and pharmacodynamics (the study of what a drug does to the body) of propofol was explored in patients undergoing a craniotomy. In our studies, we found that the frontal brain tumors influence the pharmacokinetics but not the pharmacodynamics of propofol. Second, the efficacy of new hypnotic and analgesic EEG derived drug effect measures to improve drug dosing was investigated. We conclude that the new generation of monitors represents progress compared to the current state of affairs of drug dosing based on fixed dosing schemes and hemodynamic variables. However, they all still have important shortcomings which must be addressed in future studies.",

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AB - This thesis describes the importance of anesthetic drug dose optimization and the means that anesthetists have to achieve this. Two main subjects were addressed. First, the influence of frontal brain tumor on the pharmacokinetics (the study of how an organism affects a drug) and pharmacodynamics (the study of what a drug does to the body) of propofol was explored in patients undergoing a craniotomy. In our studies, we found that the frontal brain tumors influence the pharmacokinetics but not the pharmacodynamics of propofol. Second, the efficacy of new hypnotic and analgesic EEG derived drug effect measures to improve drug dosing was investigated. We conclude that the new generation of monitors represents progress compared to the current state of affairs of drug dosing based on fixed dosing schemes and hemodynamic variables. However, they all still have important shortcomings which must be addressed in future studies.

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