Idiopathic Scoliosis, Neuromuscular Dystrophy, Spine Deformities
Conditions
Keywords
Children
Brief summary
During major spinal surgery evoked potential monitoring is performed to detect spinal cord damage. Intra-venous anaesthesia is the preferred anaesthetic technique because volatile anaesthetic agents supress the evoked potentials. Total Intra-Venous Anaesthesia (TIVA) with propofol is commonly administered as a Target Controlled Infusion (TCI). The TCI is an automated drug delivery system which administers propofol to achieve a desired blood concentration, based on an in built pharmaco-kinetic data (TCI model) derived from previous studies. The TCI model also provides a real time predicted blood concentration to facilitate the anaesthetist to adjust the target concentration of propofol. The TCI algorithm is based on pharmaco-kinetic data derived from previous studies in a relatively small number of patients, by a best fit relationship between blood levels, infusion rates and other factors (such as age and weight). Several factors make it possible for a wide discrepancy between the predicted and the true blood concentrations. This difference can be higher in children compared to adults. Also blood loss and administration of large volumes of intravenous fluids can affect the blood concentrations. This study aims to identify the difference between the predicted and true blood concentrations by using Pelorus 1500, a bedside blood propofol measurement device, in children undergoing major spinal surgery under TIVA.
Interventions
DEVICEPelorus 1500
a bedside blood propofol measurement device
DRUGPropofol 2% (Diprivan 2%, Astra Zeneca UK)
Sponsors
Great Ormond Street Hospital for Children NHS Foundation Trust
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
5 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Children undergoing major spinal surgery under propofol TCI * Surgery expecting to last more than 3 hours.
Exclusion criteria
* Major hepatic or renal disease
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The absolute difference between the measured and predicted concentrations of propofol in micrograms per ml of blood. | Up to 5 hours during the maintenance phase of anaesthesia, to allow a maximum of 10 samples at 20 to 30 min intervals. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Median Performance Error (MDPE) | Up to 5 hours during the maintenance phase of anaesthesia, to allow a maximum of 10 samples at 20 to 30 min intervals. | The median value of ratio between the measured and predicted concentration of propofol to the predicted concentration (Performance error) in blood. Expressed as a percentage. This is a measure of overall bias of the target controlled infusion. |
| Median Absolute Performance Error (MDAPE) | Up to 5 hours during the maintenance phase of anaesthesia | The median value of the ratio of the absolute difference (excluding the sign) between the measured and predicted concentrations to the predicted concentration (Absolute performance error) in blood. Expressed as percentage. This is a measure of the accuracy of the target controlled infusion. |
| Wobble | Up to 5 hours during the maintenance phase of anaesthesia | The median value of the difference between the individual performance errors and the Median Performance Error (MDPE). This is a measure of the distribution of the performance errors around the median. |
| Divergence | Up to 5 hours during the maintenance phase of anaesthesia | The median of the regression coefficient of the performance error against time. This is a measure of how the target controlled infusion performs with time. |
Countries
United Kingdom
Outcome results
None listed