Perioperative management of scoliosis correction and application of pharmacokinetic and pharmacodynamic approaches in dosing of anaesthetic drugs

Authors

  • M.M. Barsa Danylo Halytsky Lviv National Medical University, Lviv, Ukraine; Rivne Regional Clinical Hospital, Rivne, Ukraine
  • K.P. Semenchuk Rivne Regional Clinical Hospital, Rivne, Ukraine
  • Ya.M. Pidhirnyі Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.16.6.2020.216516

Keywords:

scoliosis, perioperative medicine, multimodal anesthesia, pharmacokinetics, pharmacodynamics

Abstract

Background. Anesthesiology has already become multidisciplinary science and acquires more features of perioperative me­dicine. Confirmation of this is the development and implementation of Enhanced Recovery after Surgery (ERAS) protocols in various fields of medicine. In addition, current advances in understan­ding the principles of pharmacodynamics and pharmacokinetics make it possible to accurately select the dose of the drug in order to achieve the desired concentration at the site of action, avoiding too deep ane­sthesia and creating the conditions for adequate neurophysiological monitoring during surgery. The aim of our work is to adapt the perioperative management of scoliosis correction to the recommendations of ERAS, and to introduce pharmacokinetic and pharmacodynamic approaches to the dosage of drugs for analgesia and sedation. Materials and methods. Forty patients, who underwent surgery for scoliosis and other spinal deformities, were randomly divided into two groups depending on the method of dosing and administration of fentanyl intraoperatively: group 1 — those who received fentanyl every 15–20 minutes at a dose of 100–200 μg, and group 2 — patients who received fentanyl infusions to reach the concentration of 3–6 ng/ml at the site of action. The amount of fentanyl administered per hour of surgery was evaluated, and the time of weaning the patient from the ventilator was recorded. Results. When dosing fentanyl at the target concentration and during infusions, its amount was 250 ± 50 μg per hour that was significantly different from the amount of drug administered by bolus injection, which was 350 ± 50 μg per hour. The duration of postoperative ventilation with fentanyl infusion at the target concentration was within 14.2 ± 2.1 min in contrast to bolus management, where the duration of ventilation reached 25.3 ± 6.8 min. Conclusions. The study proposes and substantiates the need for the implementation of ERAS protocols for scoliosis correction and the introduction of pharmacokinetic and pharmacodynamic approaches to the dosing of anesthestic drugs.

References

Joseph A. Janicki, Benjamin Alman. Scoliosis: Review of diagnosis and treatment. Paediatrics & Child Health. Nov 2007. Vol. 12. Iss. 9. P. 771-776. Doi: https://doi.org/10.1093/pch/12.9.771.

Nachemson A.L., Peterson L.E. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J. Bone Joint Surg. Am. 1995. 77. Р. 815-22.

Willers U., Normelli H., Aaro S., Svensson O., Hedlund R. Longterm results of Boston brace treatment on vertebral rotation in idiopathic scoliosis. Spine. 1993. 18. Р. 432-435.

Morrissy R.T., Weinstein S.L. Lovell and Winter’s Pediatric Orthopaedics. Philadelphia: Lippincott Williams & Wilkins, 2006. Р. 693-762.

Waldemar E. Wysokinski, Robert D. McBane II. Periprocedural Bridging Management of Anticoagulation Circuletion. Jul 2012. Vol. 126. Iss. 4. 24. P. 486-490.

Di Feng, Juan Wei, Jing Luo, Yi-Yang Chen, Meng-Yi Zhu, Yu Zhang, Hua Yang. Preoperative single dose of pregabalin alleviates post-operative pain: systematic review and metaanalysis. International Journal of Clinical and Experimental Medicine. 2016. 9(6). Р. 9665-9680.

Ehab Farag. Anesthesia for Spine Surgery. 2012. Р. 25-38.

Personalized Anaesthesia. Еd. by Pedro L. Gambús. Cambridge University Press, 2019.

Hugh Hemmings, Talmage Egan. Pharmacology and Physiology for Anesthesia. Foundations and Clinical Application. 2nd ed. Elsevier, 2018.

Anthony R. Absalom, Keira P. Mason. Total Intravenous Anesthesia and Target Controlled Infusions. Springer International Publishing AG, 2017.

Mohamed Mahmoud et al. Susceptibility of Transcranial Electric Motor-evoked Potentials to Varying Targeted Blood Levels of Dexme-detomidine during Spine Surgery. Anesthesiology. 2010. 112. Р. 1364-1373.

Grassin-Delyle S. et al. Optimisation of the dosage of tranexamic acid in trauma patients with population pharmacokinetic analysis. An-aesthesia. 2018. 73. Р. 719-729.

Kushagra Verma. A Comparison of Two Different Dosing Protocols for Tranexamic Acid in Posterior Spinal Fusion for Spinal Deformity: A Prospective, Randomized Trial. International Journal of Spine Surgery. Jan 2015. 9. Р. 65.

Shafer S.L. Pharmacokinetics of fentanyl administered by computer-controlled infusion pump. Anesthesiology. 1990 Dec. 73(6). Р. 1091-102.

Eleveld D.J. Pharmacokinetic-pharmacodynamic model for propofol for broad application in anaesthesia and sedation. BJA. May 2018. Vol. 120. Iss. 5. P. 942-959.

Hannivoort L.N. Development of an Optimized Pharmacokinetic Model of Dexmedetomidine Using Target-controlled Infusion in Healthy Volunteers. Anesthesiology. 2015 Aug. 123(2). Р. 357-367.

Published

2020-09-01

Issue

Section

Original Researches