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Tips and traps analyzing pediatric PK data

Authors


  • Section Editor: Neil Morton

  • Unless otherwise noted, we refer to CL and V based on unbound concentration. It is unbound concentration that drives elimination, distribution and drug effects.

  • V refers to the steady-state volume of distribution. For the special case of the one-compartment model it is the same as the initial volume of distribution. The use of volumes such as Varea or Vz is not recommended (110).

Brian J. Anderson, C/- PICU, Auckland Children’s Hospital, Park Road, Auckland, New Zealand
Email: briana@adhb.govt.nz

Summary

Pharmacokinetic (PK) and pharmacodynamic (PD) modeling has elucidated aspects of developmental pharmacology of value to the anesthetic community. The increasing sophistication of modeling techniques is associated with pitfalls that may not be readily apparent to readers or investigators. While size and age are considered primary covariates for PK models, the impact of birth on clearance maturation is poorly documented, dose in obese children is poorly investigated, pharmacologic implications of physiologic changes poorly portrayed, disease progression on drug response poorly depicted and the impact of metabolites on effect poorly illustrated. This review identifies some of these pitfalls and suggests ideas to circumvent or investigate these hazards.

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