Application Of Integrative Thermodynamic-hemodynamicpharmacokinetic Model To Propofol Anesthesia For Hypothermic Decompression
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L. Gaohua & H. Kimura
A novel strategy of propofol anesthesia is proposed to improve clinical propofol anesthesia for hypothermic decompression. Theoretical analysis is carried out based on our previously developed integrative model of thermodynamics, hemodynamics and pharmacokinetics, after introducing a linear relationship of plasma propofol concentration with temperature thresholds of thermoregulatory responses. The therapeutic strategy proposed and simulated tentatively consists of four steps, that is, (i) the elevated intracranial pressure is decreased by therapeutic cooling; (ii) the brain temperature is cooled down simultaneously; (iii) the minimum plasma propofol concentration is calculated according to the propofol-threshold relationship and (iv) an adequate propofol is administered to realize the desired minimum plasma concentration. Simulation results suggest that the proposed propofol anesthesia is more appropriate than the empirical Roberts’ step-down infusion schema for hypothermic decompression. Keywords: brain hypothermia treatment, cooling, modeling, simulation, control. 1 Introduction High intracranial pressure (ICP) is still a major cause of mortality in the intensive care unit . Therefore, achieving a sustained reduction in ICP in patients with intracranial hypertension remains a great challenge in the clinical practice. Due to its hypothermic decompression, brain hypothermia treatment has been verified to be especially effective in such patients with refractory intracranial hypertension, in whom all other conventional therapeutic options
brain hypothermia treatment, cooling, modeling, simulation, control.