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Couto M, Vide S, Marco-Ariño N, Troconiz IF, Esteves S, Nunes CS, Amorim P, Mendes J. Comparison of two pharmacokinetic-pharmacodynamic models of rocuronium bromide during profound neuromuscular block: analysis of estimated and measured post-tetanic count effect. Br J Anaesth 2022; 128:473-481. [PMID: 35120713 DOI: 10.1016/j.bja.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/14/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Profound neuromuscular block (NMB) is important in surgeries where complete immobility is considered essential to improve tracheal intubation and surgical conditions. Rocuronium bromide is a commonly used NMB agent. This work describes a noninvasive approach for estimation of post-tetanic count (PTC) based on two pharmacokinetic (PK) models, the Saldien and the De Haes models. The aim was to investigate the rocuronium bromide PK-pharmacodynamic (PD) relationship in estimating the PTC effect during profound NMB. METHODS In this prospective, non-randomised, observational study, an induction bolus of rocuronium bromide was administered followed by continuous infusion for maintenance of a PTC of 1-2. measured every 3 min. Measurements were analysed as discrete categorical data and by applying the nonlinear mixed-effect modelling approach. Performance of the selected models was evaluated through simulation model-based diagnostics, further assessing the precision of the parameter estimates and the performance of the models at the individual level. RESULTS Data from 30 adult patients undergoing elective abdominal or neurosurgical procedures were included. Post-tetanic count response profiles during rocuronium bromide infusion were successfully characterised using the population PD analysis. The models showed a good performance for all PTC categories, albeit with a moderate over-prediction of PTC >6. CONCLUSIONS Our findings indicate that using plasma concentrations of rocuronium bromide estimated with either of the two models, combined with a PD model, provides equal model performance when predicting PTC. These promising results may provide an important advance in guiding rocuronium bromide administration when profound NMB in routine clinical practice is desired.
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Affiliation(s)
- Mafalda Couto
- Department of Mechanical Engineering, Faculdade de Engenharia da Universidade do Porto, Porto, Portugal; Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Porto, Portugal.
| | - Sérgio Vide
- Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal; Systems Pharmacology Effect Control & Modeling Research Group, Anesthesiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Nicolás Marco-Ariño
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, Pamplona, Spain; Navarra Institute for Health Research (Instituto de Investigación Sanitaria de Navarra), University of Navarra, Pamplona, Spain
| | - Iñaki F Troconiz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, Pamplona, Spain; Navarra Institute for Health Research (Instituto de Investigación Sanitaria de Navarra), University of Navarra, Pamplona, Spain
| | - Simão Esteves
- Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Catarina S Nunes
- Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Porto, Portugal; Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal; Department of Sciences and Technology, Delegation of Porto, Universidade Aberta, Porto, Portugal
| | - Pedro Amorim
- Centro de Investigação Clínica em Anestesiologia, Serviço de Anestesiologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Joaquim Mendes
- Department of Mechanical Engineering, Faculdade de Engenharia da Universidade do Porto, Porto, Portugal; Instituto de Ciência e Inovação em Engenharia Mecânica e Engenharia Industrial, Porto, Portugal
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Matsubara K, Matsumoto K, Yokoyama Y, Watanabe E, Enoki Y, Shigemi A, Ikawa K, Terazono H, Morikawa N, Ohshige T, Takeda Y. Dosing Optimization of Ampicillin-Sulbactam Based on Cystatin C in Elderly Patients with Pneumonia. Biol Pharm Bull 2021; 44:732-736. [PMID: 33952829 DOI: 10.1248/bpb.b20-00781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ampicillin-sulbactam is a first-line therapy for pneumonia and is mainly excreted by the kidney. It is important to optimize the dose and dosing interval of ampicillin-sulbactam because in patients with decreased renal function and low skeletal muscle mass, such as the elderly, excess drug may burden renal function. In this study, we evaluated indices of renal function and optimized the dose and dosing interval of ampicillin-sulbactam based on pharmacokinetics (PK) and pharmacodynamics theory in elderly patients. The serum concentrations of ampicillin and sulbactam were measured by HPLC, and PK parameters were calculated. Correlations between the clearance of ampicillin or sulbactam and renal function were evaluated, and dosing optimization was calculated based on PK parameters. The PK parameters of ampicillin were CL = 6.5 ± 4.0 L/h, Vd = 19.3 ± 0.2 L, Ke = 0.4 ± 0.2, and t1/2 = 2.7 ± 1.6 h. The most correlated renal function index was estimated glomerular filtration rate (eGFRcys-c) calculated by serum cystatin-c (r = 0.7374, correlation formula; CL of ampicillin = 0.1937 × eGFRcys-c-0.6726). Based on this formula, we calculated the clearance of ampicillin and developed dosing regimens for the elderly. Serum cystatin-c concentration is an ideal index to optimize ampicillin-sulbactam antimicrobial therapy in elderly patients with pneumonia.
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Affiliation(s)
- Kayoko Matsubara
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University.,Ibusuki Kouzenkai Hospital
| | - Kazuaki Matsumoto
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Yuta Yokoyama
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Erika Watanabe
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Yuki Enoki
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Akari Shigemi
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Kazuro Ikawa
- Department of Clinical Pharmacotherapy, Hiroshima University
| | - Hideyuki Terazono
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University
| | | | | | - Yasuo Takeda
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University
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McCallum AD, Sloan DJ. The importance of clinical pharmacokinetic-pharmacodynamic studies in unraveling the determinants of early and late tuberculosis outcomes. ACTA ACUST UNITED AC 2017; 2:195-212. [PMID: 30283633 DOI: 10.4155/ipk-2017-0004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/16/2017] [Indexed: 12/17/2022]
Abstract
Tuberculosis remains a major infectious cause of morbidity and mortality worldwide. Current antibiotic regimens, constructed prior to the development of modern pharmacokinetic-pharmacodynamic (PK–PD) tools, are based on incomplete understanding of exposure–response relationships in drug susceptible and multidrug resistant tuberculosis. Preclinical and population PK data suggest that clinical PK–PD studies may enable therapeutic drug monitoring for some agents and revised dosing for others. Future clinical PK–PD challenges include: incorporation of PK methods to assay free concentrations for all active metabolites; selection of appropriate early outcome measures which reflect therapeutic response; elucidation of genetic contributors to interindividual PK variability; conduct of targeted studies on special populations (including children); and measurement of PK–PD parameters at the site of disease.
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Abstract
Research in mathematics and in mathematical biology on cancer and its treatments has been soaring in the past 10 years at an unprecedented speed. Such thriving is likely due as much to new findings in fundamental biology as to an emerging general interest from mathematicians and engineers towards applications in biology and medicine and to their subsequently designed representations and predictions of tumor processes that are now allowed by modern means of computation and simulation. This article, which does not claim the status of an extended review paper on mathematical models of cancer and its treatment, is focused on modeling in a systems biology perspective. I will list here the most necessary mathematical methods, in my opinion, which, while enforcing already existing methods, should be further developed towards designing and applying optimized individualized treatments of cancer in the clinic.
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Affiliation(s)
- Jean Clairambault
- INRIA Paris-Rocquencourt, Domaine de Voluceau, F78153 Rocquencourt, France.
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