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Ukufakwa okujoliswayo okujoliswe kuko (I-TCI) yindlela yokufaka amayeza e-IV ukuze kufezekiswe uxinaniso lweziyobisi oluchazwe ngumsebenzisi ("ithagethi") kwindawo ethile yomzimba okanye kwizicubu ezinomdla. Kolu phononongo, sichaza imigaqo ye-pharmacokinetic ye-TCI, uphuhliso lweenkqubo ze-TCI, kunye nemiba yobugcisa neyomthetho ejongwe kuphuhliso lweeprototype. Sikwachaza nokuqaliswa kweenkqubo ezikhoyo zonyango ezikhoyo ngoku.

Injongo yazo zonke iindlela zokuhambisa amayeza kukufezekisa nokugcina ixesha lonyango lesiphumo samayeza, ngelixa kuthintelwa iziphumo ezibi. Amayeza e-IV adla ngokunikezelwa kusetyenziswa izikhokelo zedosi eqhelekileyo. Ngokwesiqhelo i-covariate yesigulana efakwe kwidosi yi-metric yobukhulu besigulana, ngokuqhelekileyo ubunzima be-anesthetics ye-IV. Iimpawu zesigulana ezifana nobudala, isini, okanye i-creatinine clearance azisoloko zifakiwe ngenxa yobudlelwane obuntsonkothileyo bezibalo zezi covariates kwidosi. Ngokwembali bekukho iindlela ezimbini zokuhambisa amayeza e-IV ngexesha le-anesthesia: idosi ye-bolus kunye ne-infusion eqhubekayo. Iidosi ze-bolus zihlala zinikwa ngesirinji ephathwayo. Ii-infusions zihlala zinikwa ngepompo ye-infusion.

Lonke iyeza lokuthomalalisa iintlungu liqokelelana kwizicubu ngexesha lokunikezelwa kwamayeza. Olu qokelelo lubhidanisa ubudlelwane phakathi kwesantya sokufakwa esimiselwe yingcali yezonyango kunye noxinzelelo lwamayeza kwisigulana. Isantya sokufakwa kwepropofol se-100 μg/kg/min sinxulunyaniswa nesigulana esiphantse savuka emva kwemizuzu emi-3 emva kokufakwa kwamayeza kunye nesigulana esiphumle kakhulu okanye esilele emva kweeyure ezi-2. Ngokusebenzisa imigaqo ye-pharmacokinetic (PK) eqondwa kakuhle, iikhompyutha zinokubala ukuba ingakanani iyeza eliqokelelene kwizicubu ngexesha lokufakwa kwamayeza kwaye zinokulungisa isantya sokufakwa kwamayeza ukuze kugcinwe uxinzelelo oluzinzileyo kwi-plasma okanye kwizicubu ezinomdla, ngokuqhelekileyo ebuchotsheni. Ikhompyutha iyakwazi ukusebenzisa imodeli engcono kakhulu kwiincwadi, kuba ubunzima bezibalo bokufaka iimpawu zesigulana (ubunzima, ubude, ubudala, isini, kunye nee-biomarkers ezongezelelweyo) zizinto ezingenamsebenzi zekhompyutha.1,2 Esi sisiseko sohlobo lwesithathu lokunikezelwa kwamayeza okuthomalalisa iintlungu, i-infusions elawulwa yithagethi (TCI). Ngeenkqubo ze-TCI, ingcali yezonyango ingena kuxinzelelo olufunwayo. Ikhompyutha ibala ubungakanani beziyobisi, ezithunyelwa njengee-boluses kunye nee-infusions, ezifunekayo ukuze kufikelelwe kuxinzelelo olujoliswe kulo kwaye iqondise ipompo yokufaka i-infusion ukuhambisa i-bolus okanye i-infusion ebaliweyo. Ikhompyutha ihlala ibala ukuba ingakanani na iyeza elikwizicubu kunye nendlela elichaphazela ngayo ubungakanani beziyobisi ezifunekayo ukuze kufikelelwe kuxinzelelo olujoliswe kulo ngokusebenzisa imodeli yee-PK zeziyobisi ezikhethiweyo kunye nesigulana esisebenza kunye.

Ngexesha lotyando, inqanaba lokuvuselelwa kotyando linokutshintsha ngokukhawuleza kakhulu, lifuna i-titration echanekileyo nekhawulezileyo yesiphumo seziyobisi. Ukufakwa kwemithi ngendlela eqhelekileyo akunakunyusa uxinano lwamayeza ngokukhawuleza ngokwaneleyo ukubala ukunyuka okukhawulezileyo kokuvuselelwa okanye ukunciphisa uxinano ngokukhawuleza ngokwaneleyo ukubala amaxesha okuvuselelwa okuphantsi. Ukufakwa kwemithi ngendlela eqhelekileyo akunakugcina uxinano lwamayeza oluzinzileyo kwi-plasma okanye ebuchotsheni ngexesha lokuvuselelwa rhoqo. Ngokufaka iimodeli ze-PK, iinkqubo ze-TCI zinokukhawulezisa impendulo ye-titration njengoko kuyimfuneko kwaye ngokufanayo zigcine uxinano oluzinzileyo xa kufanelekile. Inzuzo enokubakho kwiingcali zezonyango kukufakwa kwemithi ngendlela echanekileyo ngakumbi kwesiphumo seyeza le-anesthetic.3

Kolu phononongo, sichaza imigaqo ye-PK ye-TCI, uphuhliso lweenkqubo ze-TCI, kunye nemiba yobugcisa neyomthetho ejongwe kuphuhliso lweeprototype. Amanqaku amabini ophononongo ahamba nawo agubungela imiba yokusetyenziswa nokhuseleko kwihlabathi liphela enxulumene nale teknoloji.4,5

Njengoko iinkqubo ze-TCI zazitshintsha, abaphandi bakhetha amagama angaqhelekanga kwindlela yokusebenza. Iinkqubo ze-TCI zibizwa ngokuba yi-computer-assisted total IV anesthesia (CATIA),6 titration of IV agents by computer (TIAC),7 computer-assisted continuous infusion (CACI),8 kunye ne-computer-controlled infusion pump.9 Emva kwengcebiso ka-Iain Glen, uWhite noKenny basebenzise igama elithi TCI kwiimpapasho zabo emva kowe-1992. Kwafikelelwa kwisivumelwano ngo-1997 phakathi kwabaphandi abasebenzayo sokuba igama elithi TCI lisetyenziswe njengenkcazo eqhelekileyo yetekhnoloji.10