Background: Previously, a linked pharmacokinetic-pharmacodynamic model (Kim model) of propofol was developed for children aged 2 to 12 years, allowing target-controlled infusion. Despite an increasing need for intravenous anesthesia using propofol during surgery in children younger than two years of age, no pharmacokinetic-pharmacodynamic model of propofol has been developed for this population. Therefore, in this study, we performed an external validation of Kim’s propofol model for children aged less than two years.Methods: Twenty-four children below the age of two years undergoing neurosurgery were enrolled. Anesthetic induction was commenced using a target-controlled infusion of 2% propofol based on Kim model and continuous infusion of remifentanil under bispectral index (BIS) monitoring. The target effect-site concentration of propofol was set to 2, 3, 4, and 5 g/ml, each followed by arterial blood sampling after 10 min of equilibrium. Population estimates of pooled bias, inaccuracy, divergence, and wobble were calculated to evaluate the performance of the Kim model.Results: A total of 95 plasma concentrations and 91 BIS values were used for evaluation of the Kim model. For plasma concentration of propofol, the bias was -0.96% and inaccuracy was 21.0%. For BIS, the bias was -7.7% and inaccuracy was 20.6%.Conclusions: The pooled bias and inaccuracies from the pharmacokinetic-pharmacodynamic predictions were within clinically acceptable range. Therefore, the Kim model may be applicable for propofol target-controlled infusion in children under two years of age.
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External Validation of a Pharmacokinetic-Pharmacodynamic Model of Propofol for Target-Controlled Infusion in Children Under Two Years of Age
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