Intravenous propofol anaesthesia using a computerised infusion system

White, Martin; Kenny, G. N. C.

doi:10.1111/j.1365-2044.1990.tb14685.x

Cited by 154 publications

(83 citation statements)

References 8 publications

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“…This finding concurs with other pharmacokinetic evaluations of this algorithm when used for both general anaesthesia [10] and sedation [11], although the bias was more pronounced in our study. However, an advantage of a patient-maintained sedation system is that it allows each patient to titrate the systemic concentration of propofol to a value appropriate for overall comfort.…”

Section: Discussionsupporting

confidence: 93%

“…The TCI system we used is based on an Ohmeda 9000 pump with a modified backbar containing additional computer hardware which is programmed with the pharmacokinetic parameters which describe the distribution and elimination of propofol [10]. Following the additional input of an individual patient's age and weight, a predicted target concentration of propofol (in mg.ml ¹1 ) can be selected and the computer will then make the necessary calculations of the dose of propofol required to achieve and maintain this concentration and infuse the drug accordingly.…”

Section: Methodsmentioning

confidence: 99%

“…Propofol, however, is rapidly redistributed from the central compartment so that in order to produce a stable pharmacokinetic profile, avoiding peaks and troughs in plasma concentration, it is best administered as an infusion. Continuous propofol infusions can be provided by either manual infusion schemes [8], with the drug administered in mg.min ¹1 [9], or as a target-controlled infusion (TCI) where a pharmacokinetic model is used to predict the initial bolus dose and infusion rates to achieve and maintain a given predicted target blood propofol concentration [10]. The infusion rate or target concentration can then be altered by the anaesthetist to achieve an optimal level of sedation [11].…”

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confidence: 99%

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Patient‐maintained propofol sedation

1997

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SummaryWe have developed a system which allows patients to operate a target-controlled infusion of propofol to provide sedation and we have studied its use in 36 unpremedicated patients undergoing local and regional anaesthetic procedures lasting 10-280 min. An intravenous propofol infusion was started at a target plasma level of 1 mg.ml ¹1 . The patient was able to increase the target propofol concentration in 0.2-mg.ml ¹1 increments by pressing a demand button. There was a lockout interval of 2 min and a maximum permissible target concentration of 3 mg.ml¹1 . There was considerable interindividual variability in propofol consumption (mean 39.3 mg.kg ¹1 .min ¹1 , range 3-131 mg.kg ¹1 .min ¹1 ), no cardiovascular instability and little oversedation. Eight patients required supplementary oxygen. Optimal sedation was provided at median target concentrations of 0.8-0.9 mg.ml ¹1 . The target-controlled infusion system bias was -47% and the inaccuracy was 48%. Patient satisfaction was high and 89% said that they would definitely use the technique again. This technique combines the benefits of target-controlled infusion with patient-controlled feedback and produces safe intra-operative sedation.

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Section: Discussionsupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Patient‐maintained propofol sedation

1997

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“…The use of computer-controlled infusions of propofol has been developed to overcome drawbacks of manual schemes of infusion, allowing an easier and more accurate achievement and maintenance of a desired blood concentration of propofol. 4 Coetzee and colleagues 16 have demonstrated that different pharmacokinetic sets may have an impact on the accuracy of target controlled infusion devices, when different pharmacokinetic parameter sets are used. The pharmacokinetic parameter set applied by the Diprifusor is derived from Marsh's modification of the Gepts model, 1~ and provides a median performance error of5.7%, H which can be considered to be acceptable for clinical practice.…”

Section: I~oilmentioning

confidence: 99%

Clinical assessment of target-controlled infusion of propofol during monitored anesthesia care

Casati

Fanelli

Casaletti

et al. 1999

Can J Anesth/J Can Anesth

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Purpose: To determine the plasma concentrations of propofol required to achieve different levels of sedation during monitored anesthesia care. Methods: Sixty ASA I-II, 18-65 yr-old patients, received a target-controlled continuous iv infusion of propofol. The target plasma concentration of propofol (CPt) was initially set at 0.4/Jg.ml -I. Two minutes after calculated equilibrium between plasma and effect-site concentrations, the CPt of propofol was increased by 0.2/~g.ml -~ steps until the patient showed no reaction to squeezing the trapezius. The level of sedation was assessed immediately before each increase in propofol Cpt using the Observer's Assessment of Alertness/Sedation (OAA/S) scale. Results: The CPt of propofol required to induce lethargic response to name was 1.3/Jg-ml -~ (5 ~ and 95 ~ percentiles: 1.0 -1.8/~g.ml-~), to obtain response after loud and repeated calling name was 1.7/~g-ml -~ (I .2 -2.2 /~g'ml-~), to obtain response after prodding or shaking was 2.0 ~g.ml -~ (I.6 -2.6/ag-ml-~), to obtain response after squeezing the trapezius was 2.4/Jg'ml -I (I.8 -3.0/Jg'ml-a). Patients showed no response after squeezing the trapezius at 2.8/ag.ml -I (2.0 -3.6 ~g-ml-~). Correlation between CPt propofol and sedation scores were r = 0.76, P < 0.0001. Conclusions: Target-controlled infusion of propofol provided easy and safe management of intraoperative sedation, allowing fast and predictable deepening in the level of sedation, while minimizing systemic side effects of intravenous sedation due to the minimal risk of overdosing the drug.Objectff : DEterminer les concentrations plasmatiques de propofol n&essaire pour fournir diffErents niveaux de sedation monitor&. M6thode : Soixante patients ASA I-II de 18-65 ans ont re~u une perfusion continue de propofol iv ?~ cible contr61&. La concentration plasmatique cibl& de propofol (Cpc) &ait d'abord de 0,4/lg.ml-'. Deux minutes aprEs avoir atteint I'Equilibre entre la concentration plasmatique et celle du site d'effet, la Cpc de propofol a 6tE augmentE par paliers de 0,2 pg.ml-'jusqu'~ ce que le patient ne rEagisse plus a une pression sur le trapeze, Le niveau de sedation a EtE EvaluE immEdiatement avant chaque augmentation de la Cpc de propofol fi I'aide de I'&helle de cotation de la vigilance par I'observateur/sEdation (CVO/S). R~sultats : La Cpc de propofol n&essaire pour induire une reaction IEthargique du patient ~. I'appel de son nom Etait de 1,3/Jg.ml-' (5 ~ et 95 ~ percentiles : 1,0 -1,8/Jg.ml-'), pour obtenir une reaction apt& I'appel du nom rEp&E et ~. voix forte &ait de 1,7/lg.ml-' (I,2 -2,2/~g'ml-~), pour rEagir fi une pouss& ou une secousse, 2.0 /Jg-ml -' ( 1.6 -2.6 ~g'ml-~), et pour rEagir a une pression sur le trapeze, 2,4/Jg'ml -~ ( 1,8 -3,0 pg.ml-'). Les patients n'ont pas rEagi ~ la pression sur le trapeze avec une concentration de 2,8/ag.ml-' (2,0 -3,6/~g.ml-'). La corrElation entre la Cpc de propofol et les niveaux de sedation a EtE aussi observ&, r = 0,76, P < 0,000 I. Conclusion : La perfusion de propofol ~ cible contr61& foumit une ligne de ...

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“…Target Controlled Infusion (TCI) systems provide improved convenience and control during TIVA [1]. A TCI system utilizing pharmacokinetics of Propofol is now available in the armed forces hospitals.…”

Section: Methods In Medicine Introductionmentioning

confidence: 99%