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Umlando Wokufakwa Okuqondisiwe Okulawulwayo

Ukumnika okulawulwa okuhlosiwe (I-TCI) indlela yokufaka izidakamizwa ze-IV ukuze kufinyelelwe ekugxilweni kwezidakamizwa ezichazwe umsebenzisi (“okuhlosiwe”) endaweni ethile yomzimba noma izicubu ezithakaselwayo. Kulesi sibuyekezo, sichaza imigomo ye-pharmacokinetic ye-TCI, ukuthuthukiswa kwezinhlelo ze-TCI, kanye nezindaba zobuchwepheshe nezokulawula ezibhekiswe ekuthuthukisweni kwe-prototype. Siphinde sichaze ukwethulwa kwezinhlelo zamanje ezitholakala emtholampilo.

Umgomo walo lonke uhlobo lokulethwa kwezidakamizwa ukuzuza nokugcina inkambo yesikhathi sokwelapha yomphumela wezidakamizwa, kuyilapho ugwema imiphumela emibi. Imithi ye-IV ivamise ukunikezwa kusetshenziswa imihlahlandlela ejwayelekile yokudosa. Imvamisa okuwukuphela kwe-covariate yesiguli efakwa kudosi iyimethrikhi yosayizi wesiguli, ngokuvamile isisindo se-IV yokubulala izinzwa. Izici zesiguli ezinjengobudala, ubulili, noma imvume ye-creatinine ngokuvamile azifakwa ngenxa yobudlelwane obuyinkimbinkimbi bezibalo balawa ma-covariates kumthamo. Ngokomlando kube nezindlela ezi-2 zokunikeza izidakamizwa ze-IV phakathi ne-anesthesia: umthamo we-bolus kanye nokumnika okuqhubekayo. Imithamo ye-Bolus ivamise ukulawulwa ngesirinji ephathwa ngesandla. Ama-infusions ngokuvamile aphathwa ngephampu yokufaka.

Wonke umuthi obulala izinzwa unqwabelana esicutshini ngesikhathi sokulethwa kwezidakamizwa. Lokhu kunqwabelana kudida ubudlelwane phakathi kwezinga lokumnika elibekwe udokotela kanye nokugcwala kwezidakamizwa esigulini. Izinga lokufakwa kwe-propofol lika-100 μg/kg/min lihlotshaniswa nesiguli esicishe sibe siphapheme imizuzu emi-3 ekufakweni kanye nesiguli esilalise kakhulu noma esilele amahora angu-2 kamuva. Ngokusebenzisa izimiso ze-pharmacokinetic (PK) eziqondwe kahle, amakhompuyutha angakwazi ukubala ukuthi singakanani isidakamizwa esinqwabelene ezicutshini ngesikhathi sokufakwa futhi angalungisa izinga lokufakwa ukuze kugcinwe ukugxila okuzinzile ku-plasma noma izicubu zentshisekelo, ngokuvamile ubuchopho. Ikhompiyutha iyakwazi ukusebenzisa imodeli engcono kakhulu evela ezincwadini, ngoba ubunzima bezibalo bokufaka izici zesiguli (isisindo, ubude, ubudala, ubulili, kanye nama-biomarker engeziwe) kuyizibalo ezingathi sína zekhompiyutha.1,2 Lesi yisisekelo se-a uhlobo lwesithathu lokulethwa kwezidakamizwa ezibulala izinzwa, i-target-controlled infusions (TCI). Ngezinhlelo ze-TCI, umtholampilo ungena ekugxilweni okuhlosiwe okufiswayo. Ikhompuyutha ibala inani lomuthi, olethwa njengama-boluses kanye nokuxutshwa, okudingekayo ukuze kufinyelelwe ukugxiliswa okuqondisiwe futhi iqondise iphampu yokufaka ukuze ilethe i-bolus ebaliwe noma ukumnika. Ikhompuyutha ihlale ibala ukuthi singakanani umuthi esicutshini kanye nokuthi lokho kunomthelela kanjani kwinani lomuthi odingekayo ukuze kufinyelelwe ekugxiliseni okuqondisiwe ngokusebenzisa imodeli yama-PK womuthi okhethiwe kanye nesiguli esihamba ngaso.

Ngesikhathi sokuhlinzwa, izinga lokuvuselela ukuhlinzwa lingashintsha ngokushesha okukhulu, lidinga ukucaciswa okunembile, okusheshayo komphumela wezidakamizwa. Ukufakwa okuvamile akukwazi ukukhuphula ukugxila kwezidakamizwa ngokushesha ngokwanele ukuze kubangele ukwanda okungazelelwe kokukhuthazwa noma ukwehlisa ukugxilisa ingqondo ngokushesha ngokwanele ukubala izikhathi zokukhuthazwa okuphansi. Ukufakwa okuvamile akukwazi ngisho nokugcina ukugxila kwezidakamizwa okuzinzile ku-plasma noma ebuchosheni ngezikhathi zokukhuthazwa njalo. Ngokuhlanganisa amamodeli e-PK, amasistimu e-TCI angakwazi ukuhlehlisa ngokushesha impendulo njengoba kudingeka futhi ngokufanayo alondoloze ukugxila okuzinzile lapho kufanele. Inzuzo engaba khona kubahlengikazi ukucaciswa okunembe kakhudlwana komphumela womuthi obulala izinzwa.3

Kulesi sibuyekezo, sichaza imigomo ye-PK ye-TCI, ukuthuthukiswa kwezinhlelo ze-TCI, nezindaba zobuchwepheshe nezokulawula okukhulunywa ngazo ekuthuthukisweni kwesibonelo. Izindatshana ezimbili zokubuyekeza ezihambisana nalokhu zihlanganisa ukusetshenziswa komhlaba wonke kanye nezindaba zokuphepha ezihlobene nalobu buchwepheshe.4,5

Njengoba izinhlelo ze-TCI zivela, abaphenyi bakhetha amagama angenangqondo endlela yokusebenza. Izinhlelo ze-TCI zibizwe ngokuthi yi-computer-assisted total IV anesthesia (CATIA), 6 titration of IV agents by computer (TIAC),7 computer-assisted continuous infusion (CACI),8 kanye ne-computer-controlled infusion pump.9 Ngokulandela isiphakamiso ngu-Iain Glen, White kanye noKenny basebenzisa igama elithi TCI ezincwadini zabo ngemva kuka-1992. Kwafinyelelwa ukuvumelana ngo-1997 phakathi kwabaphenyi abakhuthele ukuthi igama elithi TCI lamukelwe njengencazelo evamile yobuchwepheshe.10