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Age Related Changes of the PK-PD of Intravenous Anaesthetics

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Advances in Modelling and Clinical Application of Intravenous Anaesthesia

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 523))

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Abstract

It is clinical common sense that the dose of anaesthetics must be reduced in the elderly. The therapeutic window of most hypnotics, opiates and muscle relaxants is wide. The most serious side effects of the newer therapeutics are hypotension and bradycardia. These adverse effects are often due to overdosing, but even with appropriate dosing for the desired effect, such as hypnosis, haemodynamic changes can be observed. At the end of anaesthesia the desired intra-operative effect becomes an undesired effect if it is not terminated in a timely manner. That is, prolonged sedation and residual muscle relaxation can harm the patient in the postoperative period. Prolonged analgesia is not a concern of opiate administration but respiratory depression, which is clinically irrelevant in the ventilated patient, becomes a serious side effect during the recovery period. Dosing recommendations of anaesthetics are nearly uniformly based on weight. Theoretically this dosing approach is based on the notion that drug distribution is linearly correlated with weight. In other disciplines, for instance oncology, dosing is based on body surface area. Weight and body surface area are covariates of drug distribution and elimination. In the past, whether to dose proportional to weight or to body surface area was based more on tradition than on scientific reasons.1 There are other covariates, which should be explored and probably included into dosing.

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Authors and Affiliations

  1. Department of Anaesthesiology, St Gallen, Switzerland, University of Sydney, Australia

    Thomas W. Schnider & Charles F. Minto

  2. Department of Anaesthesia and Pain Management, University of Sydney, Australia

    Thomas W. Schnider & Charles F. Minto

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  1. Thomas W. Schnider
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  2. Charles F. Minto
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Editors and Affiliations

  1. Leiden University Medical Centre, Leiden, The Netherlands

    Jaap Vuyk

  2. University of Ulm, Ulm, Germany

    Stefan Schraag

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Schnider, T.W., Minto, C.F. (2003). Age Related Changes of the PK-PD of Intravenous Anaesthetics. In: Vuyk, J., Schraag, S. (eds) Advances in Modelling and Clinical Application of Intravenous Anaesthesia. Advances in Experimental Medicine and Biology, vol 523. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-9192-8_5

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  • DOI: https://doi.org/10.1007/978-1-4419-9192-8_5

  • Publisher Name: Springer, Boston, MA

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