Design of a pharmacokinetic-pharmacodynamic model for administration of
low dose peripheral norepinephrine during general anaesthesia
Abstract
Introduction: Poor intra-operative blood pressure is a risk factor for
kidney, heart, and cognitive post-operative complications. Literature
suggests that use of low-dose peripheral norepinephrine (NOR) reduces
organ dysfunction, yet its administration remains unstandardized. In
this work we develop a pharmacokinetic/pharmacodynamics (PK/PD) model of
NOR effect on mean arterial pressure (mAP). Methods: From June 2018 to
December 2021, we included patients scheduled for elective neurosurgery
and requiring vasopressors for intra-operative hypotension management at
Lariboisière Hospital, Paris. Low doses of NOR were administered
peripherally, and successive arterial blood samples were collected to
track its plasmatic concentration. We used a compartmental modelling
approach for NOR PK. We developed and compared two models for NOR PD on
mAP. Model comparison was done using Bayes information criteria. The
resulting PK/PD model parameters were fitted over the entire population
and linked to age, weight, height and sex. Results: We included 29
patients (age 52[46-64] years, 69% female). NOR median time to peak
effect on mAP was 74[53-94] seconds. After bolus administration, mAP
increased by 24% [15 - 31]. A 3-comparments model best captured NOR
PK. NOR PD effect on mAP was well represented by both Emax and
Windkessel models, with better results for the former. We found that
age, height and weight as well as history of smoking and hypertension
were correlated with model parameters. Conclusions: We developed a PK/PD
model to accurately track norepinephrine plasma concentration and its
effect on mAP over time, which could serve for target-controlled
infusion. Study registration: ClinicalTrials.gov (NCT03454204)