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British Journal of Anaesthesia, 2002, Vol. 88, No. 1 38-45
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Predictive performance of a physiological model for enflurane closed-circuit anaesthesia: effects of continuous cardiac output measurements and age-related solubility data

P. M. Vermeulen*,1, C. J. Kalkman1, R. Dirksen2, J. T. A. Knape1, K. G. M. Moons1,3 and G. F. Borm4

1Division of Peri-operative Care, Anaesthesia and Pain Medicine, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands. 2Department of Anesthesiology, St Maartenskliniek, Nijmegen, The Netherlands. 3Julius Centre for General Practice and Patient Oriented Research, (UMCU), Utrecht, The Netherlands. 4Department of Medical Statistics, N.V. Organon, Oss, The Netherlands*Corresponding author: University Medical Centre Utrecht (UMCU), DPAP E03.511, Heidelberglaan 100, Postbus 85500, NL-3508 GA Utrecht, The Netherlands

Background. The disposition of inhalation anaesthetics is governed by the factors described in the Fick principle.

Methods. We have recalibrated a previously validated physiological model for enflurane closed-circuit inhalation anaesthesia, using individual continuous cardiac output measurements as well as age-related enflurane solubility coefficients as inputs to the model. Two model versions using ‘calculated’ (Brody’s formula) or ‘measured’ (thoracic electrical bioimpedance) cardiac output values, and two versions with ‘standard’ (fixed) or ‘age-related’ solubility coefficients were formulated.

Results. Data from 62 ophthalmic surgical patients were used to validate the predictive performance of the four model versions. The root mean squared errors (total error) and scatters (error variation) were similar with the extended model versions, but the group biases (systematic error component) were significantly less with the model versions that included age-related solubility compared with the versions using standard solubility coefficients (bias –0.76/–0.78% vs –3.44/–3.60%).

Conclusion. The inclusion of age-related solubility coefficients but not of continuous cardiac output measurements improves the predictive performance of the physiological model for closed-circuit inhalation anaesthetic conditions in routine clinical practice.

Br J Anaesth 2002; 88: 38–45


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