Practical use of ‘Diprifusor’ systems

Engbers, Frank H. M.

doi:10.1111/j.1365-2044.1998.53s112.x

Cited by 19 publications

(6 citation statements)

References 16 publications

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“…At present, there are two commercially available infusion pumps which incorporate the "Diprifusor" module, namely the Graseby 3500 (Graseby Medical Ltd) and the Vial Master TCI (Fresenius Vial SA, originally developed by Becton Dickinson). Both pumps are reliable and easy to handle [106]. However, it has been demonstrated that the actual blood concentrations of propofol are underestimated following administration by these systems and that the performance of computercontrolled infusion devices is highly dependent on the pharmacokinetic parameters implemented in the system.…”

Section: Target Controlled Infusion (Tci) and Novel Controlled Drug Dmentioning

confidence: 96%

Propofol in Anesthesia. Mechanism of Action, Structure-Activity Relationships, and Drug Delivery

Trapani¹,

Altomare²,

Sanna³

et al. 2000

CMC

343

209

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Propofol (2,6-diisopropylphenol) is becoming the intravenous anesthetic of choice for ambulatory surgery in outpatients. It is extensively metabolized, with most of the administered dose appearing in the urine as glucuronide conjugates. Favorable operating conditions and rapid recovery are claimed as the main advantages in using propofol, whereas disadvantages include a relatively high incidence of apnea, and blood pressure reductions. Besides a literature summary of the pharmacodynamics, pharmacokinetics, toxicology, and clinical use, this review provides a deeper discussion on the current understanding of mechanism of action and structure-activity relationships, and recent findings on drug delivery technologies as applied to the improvement of propofol formulations. The action of propofol involves a positive modulation of the inhibitory function of the neurotransmitter gama-aminobutyric acid (GABA) through GABAA receptors. Recent results from recombinant human GABAA receptor experiments and findings from the work exploring the effects at other receptors (e.g., glycine, nicotinic, and M1 muscarinic receptors) are reviewed. Studies showing its antiepileptic and anxiolytic properties are also discussed. The structure-activity relationships (SAR) of series of alkylphenols and p-X-substituted congeners have been reinvestigated. Interestingly, unlike the other congeners tested sofar, p-iodo-2,6-diisopropylphenol displayed anticonvulsant and anticonflict effects, but not sedative-hypnotic and anesthetic properties. Due to its high lipid-solubility, propofol was initially formulated as a solution with the surfactant Cremophor EL, but the occurrence of pain on injection and anaphylactoid reactions prompted to search for alternative formulations. Results from using cyclodextrins, water-soluble prodrugs, and adopting Bodor's approach to the site-specific chemical delivery system (CDS), as well as the advantages provided by computer-controlled infusion systems, are examined in some detail.

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Section: Target Controlled Infusion (Tci) and Novel Controlled Drug Dmentioning

confidence: 96%

Propofol in Anesthesia. Mechanism of Action, Structure-Activity Relationships, and Drug Delivery

Trapani¹,

Altomare²,

Sanna³

et al. 2000

CMC

343

209

View full text Add to dashboard Cite

show abstract

“…The Diprifusor (AstraZeneca International PLC, London, UK) is the most commonly available TCI device [5,6]. It targets plasma-site concentration and is oriented with prefilled propofol syringes.…”

Section: Introductionmentioning

confidence: 99%

Propofol concentration requirement for laryngeal mask airway insertion was highest with the ProSeal, next highest with the Fastrach, and lowest with the Classic type, with target-controlled infusion

Handa-Tsutsui

Kodaka

2005

Journal of Clinical Anesthesia

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“…With target-controlled infusion of propofol there is a trade-off between the speed of induction and adverse respiratory and haemodynamic effects [11]. Use of a low target will reduce hypotension and apnoea but will delay the time to loss of consciousness, whereas a high target produces induction times comparable with a manual bolus but with more adverse effects.…”

mentioning

confidence: 99%

“…Use of a low target will reduce hypotension and apnoea but will delay the time to loss of consciousness, whereas a high target produces induction times comparable with a manual bolus but with more adverse effects. We chose initially to select a target of 8 mg.ml ¹1 in our unpremedicated patients as this would provide a degree of 'overpressure', analogous to a high inspired sevoflurane concentration, causing a rapid rise in the effect site concentration [11]. Furthermore, concentrations > 6 mg.ml ¹1 are required for reliable success in placing the LMA [12].…”

mentioning

confidence: 99%

Target‐controlled propofol vs. sevoflurane: a double‐blind, randomised comparison in day‐case anaesthesia

Smith

Thwaites

1999

Anaesthesia

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SummaryWe compared target-controlled propofol with sevoflurane in a randomised, double-blind study in 61 day-case patients. Anaesthesia was induced with a propofol target of 8 mg.ml ¹1 or 8% sevoflurane, reduced to 4 mg.ml ¹1 and 3%, respectively, after laryngeal mask insertion and subsequently titrated to clinical signs. Mean (SD) times to unconsciousness and laryngeal mask insertion were significantly shorter with propofol [50 (9) s and 116 (33) s, respectively] than with sevoflurane [73 (14) s and 146 (29) s; p < 0.0001 and p ¼ 0.0003, respectively]; however, these differences were not apparent to the blinded observer. Propofol was associated with a higher incidence of intra-operative movement (55 vs. 10%; p ¼ 0.0003), necessitating more adjustments to the delivered anaesthetic. Emergence was faster after sevoflurane [5.3 (2.2) min vs. 7.1 (3.7) min; p ¼ 0.027], but the inhaled anaesthetic was associated with more nausea and vomiting (30 vs. 3%; p ¼ 0.006), which delayed discharge [258 (102) min vs. 193 (68) min; p ¼ 0.005]. Direct costs were lower with sevoflurane but nausea would have increased indirect costs. Patient satisfaction was high (Ն 90%) with both techniques. In conclusion, both techniques had advantages and disadvantages for day-case anaesthesia.

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Practical use of ‘Diprifusor’ systems

Cited by 19 publications

References 16 publications

Propofol in Anesthesia. Mechanism of Action, Structure-Activity Relationships, and Drug Delivery

Propofol in Anesthesia. Mechanism of Action, Structure-Activity Relationships, and Drug Delivery

Propofol concentration requirement for laryngeal mask airway insertion was highest with the ProSeal, next highest with the Fastrach, and lowest with the Classic type, with target-controlled infusion

Target‐controlled propofol vs. sevoflurane: a double‐blind, randomised comparison in day‐case anaesthesia

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