Perioperative Medicine  |   June 2017
An Allometric Model of Remifentanil Pharmacokinetics and Pharmacodynamics
Author Notes
  • Department of Anesthesiology, University Medical Center Groningen, University of Groningen, The Netherlands (D.J.E., J.H.P., H.V., A.R.A., M.M.R.F.S.); Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands (E.O., J.V.); and Department of Anesthesia, Ghent University, Gent, Belgium (M.M.R.F.S.).
  • Submitted for publication October 29, 2015. Accepted for publication August 9, 2016.
    Submitted for publication October 29, 2015. Accepted for publication August 9, 2016.×
  • Corresponding articles on pages 993 and 1019.
    Corresponding articles on pages 993 and 1019.×
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    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Address correspondence to Dr. Eleveld: Department of Anesthesiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. d.j.eleveld@umcg.nl. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Pain Medicine / Pharmacology
Perioperative Medicine   |   June 2017
An Allometric Model of Remifentanil Pharmacokinetics and Pharmacodynamics
Anesthesiology 6 2017, Vol.126, 1005-1018. doi:10.1097/ALN.0000000000001634
Anesthesiology 6 2017, Vol.126, 1005-1018. doi:10.1097/ALN.0000000000001634
Abstract

Background: Pharmacokinetic and pharmacodynamic models are used to predict and explore drug infusion schemes and their resulting concentration profiles for clinical application. Our aim was to develop a pharmacokinetic-pharmacodynamic model for remifentanil that is accurate in patients with a wide range of age and weight.

Methods: Remifentanil pharmacokinetic data were obtained from three previously published studies of adults and children, one of which also contained pharmacodynamic data from adults. NONMEM was used to estimate allometrically scaled compartmental pharmacokinetic and pharmacodynamic models. Weight, age, height, sex, and body mass index were explored as covariates. Predictive performance was measured across young children, children, young adults, middle-aged, and elderly.

Results: Overall, 2,634 remifentanil arterial concentration and 3,989 spectral-edge frequency observations from 131 individuals (55 male, 76 female) were analyzed. Age range was 5 days to 85 yr, weight range was 2.5 to 106 kg, and height range was 49 to 193 cm. The final pharmacokinetic model uses age, weight, and sex as covariates. Parameter estimates for a 35-yr-old, 70-kg male (reference individual) are: V1, 5.81 l; V2, 8.82 l; V3, 5.03 l; CL, 2.58 l/min; Q2, 1.72 l/min; and Q3, 0.124 l/min. Parameters mostly increased with fat-free mass and decreased with age. The pharmacodynamic model effect compartment rate constant (ke0) was 1.09 per minute (reference individual), which decreased with age.

Conclusions: We developed a pharmacokinetic-pharmacodynamic model to predict remifentanil concentration and effect for a wide range of patient ages and weights. Performance exceeded the Minto model over a wide age and weight range.