We achieved a relatively simple and practical covariate model in which the variability of pharmacokinetics within the study population could be ascribed principally to variability in clearance from the central compartment. Pharmacokinetic simulation predicted an improved performance of the TCI system when employing the derived covariates model, especially in elderly female patients.

Most patients undergoing major aortic surgery have multiple comorbidities and are at high risk of postoperative complications that affect multiple organ systems. Different aortic pathologies and surgical repair techniques have specific impact on the postoperative course. Ischemia-reperfusion injury is the common denominator in aortic surgery and influences the integrity of end-organ function. Common postoperative problems include hemodynamic instability due to the immediate inflammatory response, renal impairment, spinal cord ischemia, respiratory failure with prolonged mechanical ventilation, and gastrointestinal symptoms such as ileus or mesenteric ischemia. Focused care bundles to establish homeostasis and a team working toward an early functional recovery determine the success of effective rehabilitation and outcomes after aortic surgery.

to intubation difficulty, and therefore captures indices of difficulty common to both direct and indirect laryngoscopes. While the heaviest weight is given to the Cormack and Lehane grade, this appears reasonable, as reduced glottic view is a significant contributor to difficult laryngoscopy with both direct and indirect laryngoscopes. However, as stated in the original study, 2 glottic exposure alone is an incomplete reflection of the degree of tracheal intubation difficulty and the authors allocated a maximum of three points to the Cormack and Lehane score, meaning that the contribution of this variable to the overall score is 'moderate and quickly saturated'. This is borne out by the findings from our current study. It can be seen from Table 1, indicating the breakdown of IDS scores for each component, that the scores for the Macintosh were higher than those for the Glidescope w and Pentax AWS w for each of the seven components of the IDS score. These findings demonstrate that the differences in IDS score were not simply due to differences in the component pertaining to the Cormack and Lehane grade obtained at laryngoscopy, but rather were spread across several of the variables used to calculate the IDS score.Combes and Dhonneur also make the point that an alternative to the IDS score should be developed and validated for use with indirect laryngoscopes. A scoring system for difficulty of tracheal intubation, validated for use with both direct and indirect laryngoscopes, would indeed be welcome. However, any such scoring system will have to perform at least as well as the IDS score, which has been in widespread use for more than 10 yr, and will have to function equally well for both direct and indirect laryngoscopes, if it is to make a useful contribution to the field.

Over the last 10 years the technique of target-controlled infusion (TCI) has substantially influenced the development and practice of intravenous anaesthesia. It opened the possibility of many new and exciting applications of perioperative anaesthetic care. More recent and current developments, such as open TCI (target-controlled infusion) and the availability of generic anaesthetic agents combined with modern infusion pumps, means that TCI can become a standard procedure in anaesthesia and is no longer just a research tool for specialists and enthusiasts. This review explains the fundamentals and applications of intravenous drug delivery by TCI and gives practice guidelines to successfully implement the technique into clinical practice. The aim is to provide a comprehensive reference based on clinically proven evidence.

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