Comparison of the intentions of residents and licensed anesthesiologists to adapt propofol, sufentanil and sevoflurane titration according to the patient’s age

Keywords:

Pharmacodynamics, simulation training, drug titration


Published online: May 17 2024

https://doi.org/10.56126/

P. Tomassen1, F. Van Laere2, A. Kalmar3,4, H. Vereecke4,5

1 UZ Gent, Dept of Anaesthesiology, Ghent, Belgium
2 UZLeuven, Dept of Anaesthesiology, Leuven, Belgium
3 Ghent University, Dept of Electronics and Information Systems, IBiTech, Ghent, Belgium
4 AZ Sint-Jan Brugge Oostende,Dept of Anaesthesiology, Bruges, Belgium
5 University Medical Center Groningen and University of Groningen, Dept of Anaesthesiology, Groningen, Netherlands

Abstract

Background: This study uses pharmacokinetic-pharmacodynamic (PKPD) simulations, identical to those applied in SmartPilot® View (SPV) (Dräger, Lübeck, Germany), to compare whether residents adapt the dose of propofol, sufentanil and sevoflurane to the patients age in a similar effective way as licensed anesthesiologists. By comparing the drug titration intentions, we aim to identify gaps in knowledge or suboptimal performance for drug titration, so to improve future educational strategies using PKPD simulations.

Objectives: The aim is to develop, implement and evaluate a protocol for the application of FIB in the emergency department for patients with hip fractures at the University Hospital of Antwerp. Additionally, a survey was conducted on analgesia policies for hip fractures in hospitals in Flanders.

Materials and Methods: After EC approval (AZ Sint Jan Brugge-Oostende AV, nr B0492021000026) a survey was conducted in four Belgian hospitals, inquiring for titration intentions by residents and anesthesiologists when managing laparoscopic procedures of demographically identical ASA 1 patients, apart from age (18 versus 80 years). Propofol, sufentanil, rocuronium and sevoflurane were available for use. SPV simulates the effect-site concentrations of propofol (CePROP), sufentanil (CeSUF) and sevoflurane (CeSevo), the “probability of tolerance to laryngoscopy” (PTOL), and its derivative: the “noxious stimulation response index” (NSRI). Appropriate T tests explore significant differences (p<0.05) within and between groups.

Results and Discussions: 38 residents and 30 anesthesiologists were compared. In young and old patients, high doses of propofol and sevoflurane led to near maximal values of PTOL and NSRI in both groups. Residents target higher CePROP, CeSUF en CeSEVO in young patients compared to anesthesiologists. Both groups reduce doses in elderly but without reducing PTOL values.

Conclusions: PKPD simulations could assist in drug titration training programs to optimize the adaptation of the drug dose to patients’ age, both for residents and anesthesiologists.

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Volume 74, supplement 1.

Dec 2023.

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