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ʻO ka Moʻolelo o ka Infusion-Controlled Infusion

ʻO ka infusion i hoʻopaʻa ʻia i ka pahuhopu (TCI) he ʻano hana ia o ka hoʻokomo ʻana i nā lāʻau lapaʻau IV no ka hoʻokō ʻana i ka manaʻo o ka lāʻau i wānana mua ʻia ("target") i loko o kahi keʻena kino a i ʻole nā ​​​​mea hoihoi.Ma kēia loiloi, wehewehe mākou i nā loina pharmacokinetic o TCI, ka hoʻomohala ʻana o nā ʻōnaehana TCI, a me nā pilikia ʻenehana a me nā hoʻoponopono i ʻōlelo ʻia i ka hoʻomohala prototype.Hōʻike pū mākou i ka hoʻomaka ʻana o nā ʻōnaehana i loaʻa i kēia manawa.

ʻO ka pahuhopu o kēlā me kēia ʻano o ka lawe ʻana i ka lāʻau lapaʻau ke hoʻokō a mālama i kahi papa manawa therapeutic o ka hopena lāʻau, ʻoiai e pale ana i nā hopena ʻino.Hāʻawi pinepine ʻia nā lāʻau lapaʻau IV me ka hoʻohana ʻana i nā kuhikuhi dosing maʻamau.ʻO ka mea maʻamau, ʻo ka covariate maʻi wale nō i hoʻohui ʻia i loko o kahi pānaʻi he metric o ka nui o ka mea maʻi, maʻamau ke kaumaha no IV anesthetics.ʻAʻole i hoʻokomo pinepine ʻia nā hiʻohiʻona maʻi e like me ka makahiki, ke kāne, a i ʻole ka hoʻomaʻemaʻe creatinine ma muli o ka pilina makemakika paʻakikī o kēia mau covariates i ka nui.Ma ka mōʻaukala, aia 2 mau ʻano o ka lawelawe ʻana i nā lāʻau lapaʻau IV i ka wā anesthesia: bolus dose a me ka infusion mau.Hoʻohana pinepine ʻia nā dosis Bolus me kahi syringe paʻa.Hoʻohana maʻamau ʻia nā infusions me kahi pamu infusion.

ʻO kēlā me kēia lāʻau anesthetic e hōʻiliʻili i loko o ka ʻiʻo i ka wā o ka lawe ʻana i ka lāʻau.Hoʻopili kēia hōʻiliʻili i ka pilina ma waena o ka infusion rate i hoʻonohonoho ʻia e ke kauka a me ka hoʻopaʻa ʻana o ka lāʻau i ka mea maʻi.Hoʻopili ʻia kahi propofol infusion rate o 100 μg/kg/min me kahi mea maʻi kokoke ala 3 mau minuke i loko o ka infusion a me kahi mea maʻi hoʻomaha a hiamoe paha 2 mau hola ma hope.Ma ka hoʻohana ʻana i nā loina pharmacokinetic (PK) i hoʻomaopopo maikaʻi ʻia, hiki i nā kamepiula ke helu i ka nui o ka lāʻau i hōʻiliʻili ʻia i loko o nā ʻiʻo i ka wā o ka infusions a hiki ke hoʻoponopono i ka helu infusion e mālama i ka neʻe paʻa i ka plasma a i ʻole ka ʻiʻo hoihoi, maʻamau ka lolo.Hiki i ke kamepiula ke hoʻohana i ke kumu hoʻohālike maikaʻi loa mai ka palapala, no ka mea, ʻo ka paʻakikī makemakika o ka hoʻokomo ʻana i nā ʻano maʻi (ke kaumaha, ke kiʻekiʻe, ka makahiki, ke kāne, a me nā biomarkers hou aʻe) he helu liʻiliʻi no ka kamepiula.1,2 ʻO kēia ke kumu o kahi ʻO ke kolu o ke ʻano o ka hāʻawi ʻana i ka lāʻau anesthetic, nā infusions i hoʻopaʻa ʻia i ka pahuhopu (TCI).Me nā ʻōnaehana TCI, komo ke kauka i ka manaʻo i makemake ʻia.Hoʻopili ke kamepiula i ka nui o ka lāʻau lapaʻau, hāʻawi ʻia ma ke ʻano he bolus a me nā infusions, pono e hoʻokō i ka manaʻo i hoʻopaʻa ʻia a kuhikuhi i kahi pamu infusion e hoʻopuka i ka bolus i helu ʻia a i ʻole infusion.Ke helu mau nei ke kamepiula i ka nui o ka lāʻau i loko o ka ʻiʻo a me ke ʻano o ka hoʻololi ʻana i ka nui o ka lāʻau i koi ʻia e hoʻokō i ka manaʻo i hoʻopaʻa ʻia ma o ka hoʻohana ʻana i kahi kumu hoʻohālike o nā PK o ka lāʻau i koho ʻia a me ka mea maʻi covariates.

I ka wā o ke kaʻa ʻana, hiki ke loli koke ke kiʻekiʻe o ka hoʻoulu ʻana i ka lāʻau, e koi ana i ka titration wikiwiki o ka hopena lāʻau.ʻAʻole hiki i nā infusions maʻamau ke hoʻonui wikiwiki i ka nui o ka lāʻau no ka hoʻonui koke ʻana i ka hoʻoulu ʻana a i ʻole ka hoʻohaʻahaʻa wikiwiki ʻana i ka helu no nā manawa haʻahaʻa haʻahaʻa.ʻAʻole hiki i nā infusions maʻamau ke mālama i nā ʻano lāʻau lapaʻau paʻa i ka plasma a i ʻole ka lolo i ka wā o ka hoʻoulu mau ʻana.Ma ka hoʻokomo ʻana i nā hiʻohiʻona PK, hiki i nā ʻōnaehana TCI ke hoʻopaʻa wikiwiki i ka pane e like me ka mea e pono ai a mālama like i nā manaʻo paʻa ke kūpono.ʻO ka pōmaikaʻi hiki i nā kauka lapaʻau ke ʻoi aku ka pololei o ka titration o ka hopena lāʻau anesthetic.3

Ma kēia loiloi, wehewehe mākou i nā loina PK o TCI, ka hoʻomohala ʻana i nā ʻōnaehana TCI, a me nā pilikia ʻenehana a me nā hoʻoponopono i ʻōlelo ʻia i ka hoʻomohala prototype.ʻElua mau ʻatikala loiloi e pili ana i ka hoʻohana honua a me nā pilikia palekana e pili ana i kēia ʻenehana.4,5

I ka ulu ʻana o nā ʻōnaehana TCI, ua koho nā mea noiʻi i nā huaʻōlelo idiosyncratic no ke ʻano.Ua kapa ʻia nā ʻōnaehana TCI ma ke ʻano he anesthesia āpau IV kōkua kamepiula (CATIA), 6 titration of IV agents by computer (TIAC), 7 computer-assisted continuous infusion (CACI),8 a me ka computer-controlled infusion pump.9 Ma hope o kahi manaʻo. na Iain Glen, White a me Kenny i hoʻohana i ka huaʻōlelo TCI i kā lākou mau puke ma hope o ka makahiki 1992. Ua loaʻa ka ʻaelike ma 1997 i waena o nā mea noiʻi ikaika e lawe ʻia ka huaʻōlelo TCI ma ke ʻano he wehewehe kikoʻī o ka ʻenehana.10