Comparison of two pharmacokinetic-pharmacodynamic models of rocuronium bromide during profound neuromuscular block: analysis of estimated and measured post-tetanic count effect

• Type: Article in International Scientific Journal
• Date: 2022

Authors

Couto, M (Author) Other; Vide, S (Author) Other; Marco Arino, N (Author) Other; Troconiz, IF (Author) Other; Esteves, S (Author) Other; Nunes, CS (Author) Other; Amorim, P (Author) Other; Joaquim Mendes (Author) FEUP

Journal

The Journal is awaiting validation by the Administrative Services.

Title: BRITISH JOURNAL OF ANAESTHESIA

Vol. 128

Pages: 473-481

ISSN: 0007-0912

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Authenticus ID: P-00W-22K

DOI: 10.1016/j.bja.2021.12.010

Abstract (EN): 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.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 9