Simulation of propofol anaesthesia for intracranial decompression using brain hypothermia treatment

Theoretical analysis was carried out using a previously-developed integrative model of the thermoregulatory, hemodynamic and pharmacokinetic subsystems. Propofol kinetics is described using a framework similar to that of this model and combined with the thermoregulation subsystem through the pharmacodynamic relationship between the blood propofol concentration and the thermoregulatory threshold. A propofol anaesthesia scheme for hypothermic intracranial decompression was simulated using the integrative model.Compared to the empirical anaesthesia scheme, the proposed anaesthesia scheme can reduce the required propofol dosage by more than 18%.The integrative model of the thermoregulatory, hemodynamic and pharmacokinetic subsystems is effective in analyzing the use of propofol anaesthesia for hypothermic intracranial decompression. This propofol infusion scheme appears to be more appropriate for clinical application than the empirical one.High intracranial pressure (ICP) is still a major cause of mortality in the intensive care unit [1]. Achieving a sustained reduction in ICP in patients with intracranial hypertension remains a great challenge in clinical practice. Brain hypothermia treatment has been demonstrated to be especially effective for patients with refractory intracranial hypertension, for whom conventional therapeutic options for decompression have failed [2]. About half of hypothermia treatments were introduced for the purpose of controlling refractory intracranial hypertension [3].Besides the management of intracranial temperature and pressure, the administration of anaesthesia is another important task in therapeutic hypothermia treatment. Propofol is widely used in clinical practice for brain hypothermia treatment [4]. However, the rates of propofol administration are based mainly on clinical experience and the normothermic dosage guidelines. An empirical but practical scheme, known as Roberts' step-down infusion, consists of a loading dose of 1 mg kg-1