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Current use of PK model-driven infusions in Italy

Authors: L. Novello, B. Carobbi

Title: Survey on the current use of pharmacokinetic model-driven drug delivery in small animal anaesthesia and analgesia in Italy

Journal: Veterinary Record (2010) 167, 784-788

Type: scientific paper published in an international veterinary medicine journal

Language: English

A survey about current practice of Italian veterinary surgeons with regard to the use of propofol and intravenous opioids during anaesthesia and for treatment of acute pain in small animals has been published in the November 2010 issue of Veterinary Record.

The paper shows surprising results, considering veterinary anaesthesia books do not even mention Target Controlled Infusion systems, variable rate infusions, and PK-PD of propofol and IV opioids.

Basic pharmacokinetic concepts, including multicompartment models, the design of dosing regimens, context-sensitive decrement times and recovery curves,  have been introduced to Italian veterinary surgeons in 2004. Publication of Bolus-Elimination-Transfer (BET) schemes, providing an easy way to achieve and maintain stable plasma concentrations, followed in 2007. In Italy many meetings have discussed clinical use of compartment pharmacokinetics in small animal anaesthesia since then.

The questionnaire, consisting of 2 multiple-choice-questions, was e-mailed to ISVRA members only. A total of 171 questionnaire were sent, and results are as follows:

  • response rate was 98.2%
  • 4.8% of respondents used a laptop computer interfaced with the syringe pump via a RS232 linkage and a TCI software package to administer TCI
  • 18.8% of respondents used TCI software to simulate the infusion and adjusted the infusion rate accordingly manually (manual TCI)
  • 24.2% of respondents used a BET scheme (i.e. decreased the infusion rate by steps, according to the scheme)
  • 24.2% of respondents did not use a syringe pump to administer propofol and/or IV opioids

This gives a 47.9% of respondents who preferred to use a pharmacokinetic model-driven method of drug delivery. Most of them worked in a first opinion practice.

More than 80% of respondents believed that having access to syringe pumps with TCI capability implementing small animal PK models would allow significant improvement to their practice with infusion and to the standard of care provided to their patients.

The paper suggests that CPD meetings represent an effective way of communicating knowledge about  TCI among veterinary surgeons.

Some references included in the paper are listed below

  1. EGAN, T. D. (2003) Target-controlled drug delivery: progress toward an 'intravenous vaporizer' and automated anesthetic administration. Anesthesiology 99, 1214-1219
  2. BETHS, T., GLEN, J. B., REID, J., MONTEIRO, A. M. & NOLAN, A. M. (2001) Evaluation and optimisation of a target-controlled infusion system for administering propofol to dogs as a part of a total intravenous anaesthetic technique during dental surgery. Veterinary Record 148, 198-203
  3. MUSK, G. C., PANG, D. S. J., BETHS, T. & FLAHERTY, D. A. (2005) Target-controlled infusion of propofol in dogs - evaluation of four targets for induction of anaesthesia. Veterinary Record 157, 766-770
  4. NOVELLO, L., CAROBBI, B. & RABOZZI, R. (2008) Propofol target controlled infusion (TCI) for assessment of laryngeal function in dogs: a preliminary investigation. Veterinary Surgery 37, E3
  5. NOVELLO, L. & RABOZZI, R. (2007) Rationalization of fentanyl based analgesia in cats by computer simulation. Proceedings of the 55th Societa Culturale Italiana Veterinari per Animali da Compagnia (SCIVAC) Conference. Milan, March 7 to 9, 2007. p 283
  6. NOVELLO, L. & RABOZZI, R. (2007) Development of a modified BET scheme for fentanyl-based analgesia in dogs. Proceedings of the 56th Societa Culturale Italiana Veterinari per Animali da Compagnia (SCIVAC) International Conference. Rimini, June 1 to 3, 2007. p 577
  7. NOVELLO, L. & RABOZZI, R. (2007) Target-controlled infusion of propofol for induction of anaesthesia in dogs: dose determination and effect-site equilibration delay. Proceedings of the 56th Societa Culturale Italiana Veterinari per Animali da Compagnia (SCIVAC) International Conference. Rimini, June 1 to 3, 2007. p 549
  8. NOVELLO, L., RABOZZI, R. & CAROBBI, B. (2008) Propofol effect-site concentration providing loss-of-righting-reflex (LORR) does not provide ideal conditions for laryngoscopy and tracheal intubation. Proceedings of the Association of Veterinary Anaesthetists Autumn Meeting. Barcelona, October 14 to 16, 2008. pp 98-99
  9. NOVELLO, L., RABOZZI, R., PANTI, A. & APREA, F. (2009) Propofol effect-site concentration and loss-of-righting-reflex in dogs (Abstract). Veterinary Anaesthesia and Analgesia 36, 6
  10. RABOZZI, R. & NOVELLO, L. (2007) A modified BET scheme to maintain two different concentrations of propofol at the site of drug effect in dogs. Proceedings of the 56th Società Culturale Italiana Veterinari per Animali da Compagnia (SCIVAC) International Conference. Rimini, June 1 to 3, 2007. p 557

 

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