Evaluation for Blood Concentration and Efficacy/Safety of Continuous Administration of Thiamylal in Children.

IF 2.8 4区医学 Q2 MEDICAL LABORATORY TECHNOLOGY

Therapeutic Drug Monitoring Pub Date : 2024-06-01 Epub Date: 2023-11-27 DOI:10.1097/FTD.0000000000001153

Kenshiro Hirata, Takafumi Obara, Tokunori Ikeda, Hiroshi Watanabe, Issei Fujita, Hirokazu Furusho, Takako Ishiguro, Sachiko Jingami, Toru Maruyama, Katsuki Hirai, Shigeyuki Miyamura

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引用次数: 0

Abstract

Background: Thiamylal exerts excellent sedative effects. However, it is not routinely used because of its serious adverse effects. This study aimed to clarify the target blood concentration range and infusion rate of thiamylal in children by measuring its blood concentration and evaluating its relationship with efficacy and adverse effects.

Methods: This study was approved by the Ethics Committee of Japanese Red Cross Kumamoto Hospital. The authors included 10 children aged between 1 and 7 years who had received continuous intravenous (IV) infusion of thiamylal for the management of refractory status epilepticus, excluding those who met the exclusion criteria. After a 2 mg/kg bolus injection of thiamylal, continuous IV infusion was initiated at a rate of 2-3 mg/kg/h. Thiamylal concentration in the blood was measured using high-performance liquid chromatography. The State Behavioral Scale and the frequency of bolus injections were used to evaluate efficacy. Blood pressure and heart rate were measured to evaluate adverse effects. Statistical analyses of the time to awakening and the factors affecting it were also conducted.

Results: The State Behavioral Scale score during thiamylal administration was -2 or lower in all cases, suggesting that the depth of sedation was sufficient. The frequency of bolus injections decreased in a blood concentration-dependent manner, suggesting that the frequency tended to decrease, especially at thiamylal blood concentrations of 20 mcg/mL or higher. An increase of the infusion rate to 3 mg/kg/h was recommended, because the blood concentration may not reach 20 mcg/mL at an infusion rate of 2 mg/kg/h. There was also a case in which a rapid increase in blood concentration accompanied by a decrease in blood pressure and heart rate was observed when the infusion rate was increased to 4 mg/kg/h. Furthermore, the time to awakening after the end of administration correlated with the highest blood concentration during administration; therefore, delayed awakening was noted when using a high dose of thiamylal.

Conclusions: The target blood concentration of thiamylal in children should be 20-30 mcg/mL, and the infusion rate should be based on 3 mg/kg/h.

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儿童持续给药硫柳胺的血药浓度及疗效/安全性评价。

背景:硫氨酰具有良好的镇静作用。然而，由于其严重的副作用，它并没有被常规使用。本研究旨在通过测定硫氨酰的血药浓度，评价其与疗效和不良反应的关系，明确儿童硫氨酰的靶血药浓度范围和输注速率。方法:本研究经日本红十字会熊本医院伦理委员会批准。作者纳入了10名年龄在1至7岁之间的儿童，他们接受了持续静脉滴注硫柳胺来治疗难治性癫痫持续状态，排除了符合排除标准的儿童。注射硫氨酰2 mg/kg后，开始以2-3 mg/kg/h的速率持续静脉滴注。采用高效液相色谱法测定血中硫氨酰浓度。采用状态行为量表和丸次注射次数评价疗效。测量血压和心率以评估不良反应。并对苏醒时间及影响苏醒时间的因素进行了统计分析。结果:硫柳汞给药期间的状态行为量表评分均为-2或更低，提示镇静深度足够。大剂量注射的频率呈血药浓度依赖性下降，表明注射频率有降低的趋势，特别是在硫氨酰血药浓度为20微克/毫升或更高时。建议将输注速率提高到3mg /kg/h，因为在2mg /kg/h的输注速率下，血药浓度可能达不到20mcg /mL。还有一例，当输注速率增加到4 mg/kg/h时，血药浓度迅速升高，血压和心率下降。给药结束后苏醒时间与给药期间血药浓度最高相关;因此，当使用高剂量硫胺醛时，注意到延迟觉醒。结论:儿童硫氨酰靶血药浓度宜为20 ~ 30 mcg/mL，输注速率宜以3 mg/kg/h为宜。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapeutic Drug Monitoring 医学-毒理学

CiteScore

5.00

自引率

8.00%

发文量

213

审稿时长

4-8 weeks

期刊介绍： Therapeutic Drug Monitoring is a peer-reviewed, multidisciplinary journal directed to an audience of pharmacologists, clinical chemists, laboratorians, pharmacists, drug researchers and toxicologists. It fosters the exchange of knowledge among the various disciplines–clinical pharmacology, pathology, toxicology, analytical chemistry–that share a common interest in Therapeutic Drug Monitoring. The journal presents studies detailing the various factors that affect the rate and extent drugs are absorbed, metabolized, and excreted. Regular features include review articles on specific classes of drugs, original articles, case reports, technical notes, and continuing education articles.