Target-controlled Infusion Group Research Articles

Hypotension after Anesthesia Induction: Target-Controlled Infusion Versus Manual Anesthesia Induction of Propofol.

Post-induction hypotension frequently occurs and can lead to adverse outcomes. As target-controlled infusion (TCI) obviates the need to calculate the infusion rate manually and helps safer dosing with prompt titration of the drug using complex pharmacokinetic models, the use of TCI may provide a better hemodynamic profile during anesthesia induction. This study aimed to compare TCI versus manual induction and to determine the hemodynamic risk factors for post-induction hypotension. A total of 200 ASA grade 1-3 patients, aged 24 to 82 years, were recruited and randomly assigned to the TCI (n = 100) or manual induction groups (n = 100). Hemodynamic parameters were monitored with the pressure-recording analytic method. The propofol dosage was adjusted to keep the Bispectral Index between 40 and 60. Post-induction hypotension was significantly higher in the manual induction group than in the TCI group (34% vs. 13%; p < 0.001, respectively). The propofol induction dose did not differ between the groups (TCI: 155 (135-180) mg; manual: 150 (120-200) mg; p = 0.719), but the induction time was significantly longer in the TCI group (47 (35-60) s vs. 150 (105-220) s; p < 0.001, respectively). In the multivariable Cox regression model, the presence of hypertension, stroke volume index (SVI), cardiac power output (CPO), and anesthesia induction method were found to predict post-induction hypotension (p = 0.032, p = 0.013, p = 0.024, and p = 0.015, respectively). TCI induction with propofol provided better hemodynamic stability than manual induction, and the presence of hypertension, a decrease in the pre-induction SVI, and the CPO could predict post-induction hypotension.

Uticaj tehnika anestezije na kardiovaskularnu stabilnost pacijenata podvrgnutih laparoskopskoj holecistektomiji

Background and Aim: The aim of the present study was to compare the effect of volatile induction and maintenance of anesthesia (VIMA) and target controlled infusion (TCI) on cardiovascular stability in New York Heart Association (NYHA) grade II patients who underwent laparoscopic cholecystectomy. Patients and methods: In the present study, 90 patients were randomized into two groups depending on whether they received VIMA or TCI. Heart rate, systolic, diastolic and mean arterial pressure were monitored continuously and recorded in five time intervals. Results: Statistical analysis showed that VIMA with sevoflurane provides better cardiocirculatory stability (less than 10% deviation from basal values for each measured parameter) than TCI group (p &lt; 0.01). Conclusion: Volatile induction and maintenance of anesthesia with sevoflurane provides better hemodynamic stability for NYHA II patients with concomitant cardiovascular diseases compared to TCI.

Recovery time in target controlled infusion versus manual infusion of propofol in total intravenous anaesthesia for endoscopic retrograde cholangio-pancreatography procedure using laryngeal mask airway-gastro: A randomised comparative study.

This study aimed to compare manual infusion versus target-controlled infusion (TCI) in total intravenous anaesthesia (TIVA) utilising laryngeal mask airway (LMA)-gastro during endoscopic retrograde cholangio-pancreatography (ERCP) procedures. This was a single-blind randomised trial. Patients were randomly allocated into two groups. TCI group included 27 patients, where TCI of propofol was implemented with the Schnider pharmacokinetic model driven by a computer-controlled syringe pump. The TIVA group included 27 patients with a loading dose of 2 mg/kg of propofol, followed by manual infusion of 15 mg/kg/h for the first 15 min, 13 mg/kg/h for the next 15 min, then 11 mg/kg/h for 30 min and 10 mg/kg/h for 60 min and finally maintained at 9 mg/kg/h. The primary objective was to compare recovery time following cessation of propofol infusion in both groups. The difference in the total dose of propofol, time to achieve anaesthesia induction, first attempt success rate, ease of LMA-gastro insertion, ease of insertion, success rate of endoscope device and post-anaesthesia care unit (PACU) discharge time were the secondary objectives. T-test and Chi-square test were used for statistical analysis. The time required for the recovery was significantly less in the TCI group than in the TIVA group (mean ± standard deviation; 11.60 ± 2.27 versus 15.4 ± 3.25 minutes, P < 0.001). The duration of ERCP, ease of LMA and endoscope insertion were comparable between the groups. There was no post-operative recall of intra-operative events in the groups. TCI offers earlier recovery than TIVA in patients undergoing ERCP procedures using LMA-gastro.

Sufentanil target controlled infusion (TCI) versus remifentanil TCI for monitored anaesthesia care for patients with severe tracheal stenosis undergoing fiberoptic bronchoscopy: protocol for a prospective, randomised, controlled study

IntroductionThe use of monitored anaesthesia care (MAC) is necessary and ubiquitous for fiberoptic bronchoscopy. Anaesthetic management of patients with severe tracheal stenosis has always been a challenge. The efficacy and...

Safety and efficacy of target-controlled infusion versus intermittent bolus administration of propofol for sedation in colonoscopy: a randomized controlled trial

BackgroundOur objective was to compare the safety and efficacy of Target-Controlled Infusion (TCI) versus intermittent bolus of propofol for colonoscopy sedation. MethodsWe conducted a randomized (1:1), single-blind, parallel-group superiority trial with fifty ASA I or II patients, both sexes, aged 18 to 65 years, Body Mass Index ≤ 30 kg.m−2, undergoing colonoscopy, allocated to receive propofol by TCI (effect-site, 2 μg.mL−1 plus 0.5 μg.mL−1 until unconsciousness and as necessary for agitation) or intermittent bolus (1 mg.kg−1 plus 0.5 mg.kg−1 every 5 minutes or as above). The primary safety outcome was the need for airway maneuvers and the primary efficacy outcome was the need for interventions to adjust the level of sedation. Secondary outcomes included incidence of agitation, propofol dose, and time to recovery. ResultsThe median (IQR) number of airway maneuvers and interventions needed to adjust sedation was 0 (0‒0) vs. 0 (0‒0) (p = 0.239) and 1 (0‒1) vs. 3 (1‒4) (p < 0.001) in the TCI and control groups, respectively. Agitation was more common in the intermittent bolus group ‒ 2 (0‒2) vs. 1 (0‒1), p < 0.001. The mean ± SD time to recovery was 4.9 ± 1.4 minutes in the TCI group vs. 2.3 ± 1.6 minutes in the control group (p < 0.001). The total propofol dose was higher in the TCI group (234 ± 46 µg.kg−1.min−1 vs. 195 ± 44 µg.kg−1.min−1 (p = 0.040)). ConclusionsDuring colonoscopy, TCI is as safe as intermittent bolus of propofol while reducing the incidence of agitation and the need for dose adjustments. However, intermittent bolus administration was associated with lower total propofol dose and earlier recovery.

Impact of Target-Controlled Infusion (TCI) of Propofol on State- and Response-Entropy and Sedation Depth During Flexible Bronchoscopy

Background: The increasing use of flexible bronchoscopy for diagnostic and interventional purposes requires further knowledge on feasible sedation regimens. We investigated the potential benefit of Target- Controlled Infusion (TCI) of propofol on sedation depth. Methods: Fifty-four patients scheduled for elective flexible bronchoscopy were allocated to receive propofol sedation using either intermittent boluses or Target Controlled Infusion (TCI). Endpoints included Entropy monitoring to evaluate sedation depth, sedation quality and the total amount of propofol. Results: There were no significant differences between both cohorts regarding the number of adverse sedation-related events. The mean applied dose of propofol was significantly higher in the Target-Controlled Infusion group (405±249 mg vs. 324±94 mg, p=0.015). Until patients reached loss of consciousness (LOC), State Entropy (SE) and Response Entropy (RE) levels were comparable among both sedation regimens. During the procedure, both parameters decreased to significantly lower levels in the TCI-cohort (SE: 77.7±13.2 vs. 88.8±8.6 (p=0.002) and RE: 69±12.6 vs. 79±8.7 (p=0.005)). Examination conditions, as rated by proceduralists and assisting nurses, were superior in the TCI-cohort. In addition, restraining measurements, due to uncontrolled movement during the examination needed to be applied more often to patients in the bolus cohort (body restraint: 26 (96%) vs. 18 (67%), p=0.005). Conclusion: Target-Controlled Infusion of propofol complies with the requirements of flexible bronchoscopy by providing a deep and steady level of sedation without impairing patient’s safety. In addition, there is evidence that overall sedation quality is superior, both for bronchoscopist and assisting staff.

Comparison of Postoperative Recovery after Manual and Target-Controlled Infusion of Remifentanil in Bariatric Surgery.

Background and Objectives: Early postoperative recovery after surgery is a key point for patients’ safety and comfort. Moreover, operating room turnover depends on recovery time. Our aim was to assess which method of remifentanil administration, manual (MI) or target-controlled infusion (TCI), could reduce patient time in recovery room. In this study, patients’ recovery times were registered and compared among the groups. Materials and Methods: We enrolled 31 morbidly obese patients in this prospective study. All of them had undergone bariatric surgery at the Hospital of Lithuanian University of Health Sciences Kauno Klinikos in 2020. Sevoflurane/remifentanil anaesthesia was performed for all patients. The patients were randomly assigned to the manual infusion (MI) (control group) or target-controlled infusion (TCI) group for the method of the administration of remifentanil. While the patients were waking up after the surgery, we recorded spontaneous breathing and airway reflexes recovery time, time of extubation, eye opening, recovery of orientation and beginning of the following oral command. For the TCI group, we also documented remifentanil concentrations in the blood (automatic infusion pump). Results: Patients did not differ in demographic values and duration of remifentanil infusion. We found that remifentanil consumption in the TCI group was lower, p = 0.02. Despite lower remifentanil consumption in the TCI group patients, they demonstrated longer total recovery time than the control group patiens: 14 (12–20) vs. 10 (6–16), p = 0.001. Conclusions: The study showed that, upon comparing the TCI method with MI, manual infusion produced better results in postoperative patient recovery. Additionally, higher doses of remifentanil were consumed using MI. In conclusion, the dosage recommended by highly qualified anaesthesiologists is favourable for morbidly obesity patients when compared to the TCI method.

Comparison of target controlled infusion and manual infusion of propofol for sedation in spinal anesthesia

ObjectiveThe purpose of this study was to compare the quality of sedation during surgery under spinal anesthesia with propofol using target-controlled infusion versus manual infusion regarding sedation, hemodynamics, recovery pattern, and patient and surgeon satisfaction.Subjects and methodsThis prospective randomized controlled study was performed on 60 ASA I–III patients enrolled for elective surgery under spinal anesthesia. They received propofol infusion for intraoperative sedation using target-controlled infusion or manually. The target-controlled infusion group (n = 30) received propofol with the target-controlled infusion system (Schnider’s model) with the initial target plasma concentration set at 1.5 μg ml−1. The manual infusion group (n = 30) received propofol manually in a bolus of 0.5 mg kg−1 and in maintenance doses of 1.5 mg kg−1 h−1. In both groups, the anesthesiologist adjusted to increase or decrease the infusion rate by 0.2 μg ml−1 to maintain an Observer’s Assessment of Alertness and Sedation Scale of 3–4. We recorded the amount of propofol, hemodynamics, sedation scores, VAS, BIS, patient’s and surgeon’s satisfaction, recovery pattern, and side effects.ResultsCompared with the manual infusion group, the target-controlled infusion group had a faster time to reach OAAS/3 (7.2 ± 3.47 min for the target-controlled infusion group vs 5.8 ± 1.50 min for the manual infusion group; p = 0.04) and recovery time (5.1 ± 1.70 min vs 3.6 ± 1.09 min; p < 0.001); deeper BIS levels in the 10th, 20th, and 30th minutes (p = 0.04, p = 0.03, p = 0.05); and deeper Observer’s Assessment of Alertness and Sedation Scale in the 10th and 40th minutes (p = 0.05, p = 0.03), and more surgeon’s satisfaction (p = 0.05).ConclusionIt was concluded that propofol at the same doses administered with target-controlled infusion for sedation during spinal anesthesia could be preferred due to faster sedation and recovery and more patient’s satisfaction compared to manual infusion.

Effect of subarachnoid anesthesia combined with propofol target-controlled infusion on blood loss and transfusion for posterior total hip arthroplasty in elderly patients.

Intravertebral and general anesthesia (GA) are two main anesthesia approaches but both have defects. This study was aimed to evaluate the effect of subarachnoid anesthesia combined with propofol target-controlled infusion (TCI) on blood loss and transfusion for total hip arthroplasty (THA) in elderly patients in comparison with combined spinal-epidural anesthesia (CSEA) or GA. Totally, 240 patients (aged ≥65 years, American Society of Anesthesiologists [ASA] I-III) scheduled for posterior THA were enrolled from September 1st, 2017 to March 1st, 2018. All cases were randomly divided into three groups to receive CSEA (group C, n = 80), GA (group G, n = 80), or subarachnoid anesthesia and propofol TCI (group T, n = 80), respectively. Primary outcomes measured were intra-operative blood loss, autologous and allogeneic blood transfusion, mean arterial pressure at different time points, length of stay in post-anesthesia care unit (PACU), length of hospital stay, and patient satisfaction degree. Furthermore, post-operative pain scores and complications were also observed. The difference of quantitative index between groups were analyzed by one-way analysis of variance, repeated measurement generalized linear model, Student-Newman-Keuls test or rank-sum test, while ratio index was analyzed by Chi-square test or Fisher exact test. Basic characteristics were comparable among the three groups. Intra-operative blood loss in group T (331.53 ± 64.33 mL) and group G (308.03 ± 64.90 mL) were significantly less than group C (455.40 ± 120.48 mL, F = 65.80, P < 0.001). Similarly, the autologous transfusion of group T (130.99 ± 30.36 mL) and group G (124.09 ± 24.34 mL) were also markedly less than group C (178.31 ± 48.68 mL, F = 52.99, P < 0.001). The allogenetic blood transfusion of group C (0 [0, 100.00]) was also significantly larger than group T (0) and group G (0) (Z = 2.47, P = 0.047). Except for the baseline, there were significant differences in mean arterial blood pressures before operation (F = 496.84, P < 0.001), 10-min after the beginning of operation (F = 351.43, P < 0.001), 30-min after the beginning of operation (F = 559.89, P < 0.001), 50-min after the beginning of operation (F = 374.74, P < 0.001), and at the end of operation (F = 26.14, P < 0.001) among the three groups. Length of stay in PACU of group T (9.41 ± 1.19 min) was comparable with group C (8.83 ± 1.26 min), and both were significantly shorter than group G (16.55 ± 3.10 min, F = 352.50, P < 0.001). There were no significant differences among the three groups in terms of length of hospitalization and post-operative visual analog scale scores. Patient satisfaction degree of group T (77/80) was significantly higher than group C (66/80, χ = 7.96, P = 0.004) and G (69/80, χ = 5.01, P = 0.025). One patient complained of post-dural puncture headache and two complained of low back pain in group C, while none in group T. Incidence of post-operative nausea and vomiting in group G (10/80) was significantly higher than group T (3/80, χ = 4.10, P = 0.043) and group C (2/80, χ = 5.76, P = 0.016). No deep vein thrombosis or delayed post-operative functional exercise was detected. Single subarachnoid anesthesia combined with propofol TCI seems to perform better than CSEA and GA for posterior THA in elderly patients, with less blood loss and peri-operative transfusion, higher patient satisfaction degree and fewer complications. chictr.org.cn: ChiCTR-IPR-17013461; http://www.chictr.org.cn/showproj.aspx?proj=23024.

Evaluation of a closed-loop intravenous total anesthesia delivery system with BIS monitoring compared to an open-loop target-controlled infusion (TCI) system

Introduction: Intravenous general anesthesia is an anesthetic technique that can be administered with TCI (target-controlled infusion) or closed-loop systems. The authors designed an automatic delivery system using clinical variables such as bispectral index (BIS), heart rate, and blood pressure. Objective: To evaluate the clinical and technical performance of this controller by comparing it to a TCI system. Methods: This was a single-blind, randomized, controlled clinical trial in which 150 patients were recruited: 75 for the TCI group and 75 for the closed loop with BIS. Clinical performance was determined according to the mean percentage of time spent in the BIS range of 40 to 60 during anesthetic maintenance. In addition, adequate intraoperative analgesia, technical performance, intraoperative awakening, and intraoperative recall were evaluated. Results: The primary outcome showed a mean BIS time between 40 and 60 for the closed loop of 75.24% (± 15.78) versus 59.5% (± 20.3) for the TCI system, with an absolute difference of 15.8%, 95% confidence interval (CI): 9.9 to 21.65, P < 0.0001. The mean time in intraoperative analgesia was 82.4% (25.1) in closed loop and 70.77% (± 32.8) in TCI, with a difference of 4.76 (95% CI: 2.23-21.06), P = 0.016. There was no difference in intraoperative recall. Conclusion: The closed-loop system was better at maintaining a BIS in the range of 40 to 60 during a general anesthetic than the open system or TCI.

Comparison of target-controlled infusion and manual infusion for propofol anaesthesia in children

BackgroundOne major criticism of prolonged propofol-based total i.v. anaesthesia (TIVA) in children is the prolonged recovery time. As target-controlled infusion (TCI) obviates the need to manually calculate the infusion rate, the use of TCI may better match clinical requirements, reduce propofol dose, and shorten recovery time. MethodsChildren of ASA grade 1, aged 1–12 yr, were recruited and randomly assigned to TCI or manual infusion. Children in the TCI group had propofol delivered by TCI. Children for manual infusion had a loading dose of 2.5 mg kg−1 with subsequent infusion rates of 15, 13, 11, 10, and 9 mg kg−1 h−1. Attending anaesthesiologists adjusted the propofol dosage to keep the Bispectral Index™ (BIS) between 40 and 60. ResultsSeventy-four children completed the study. The time taken to extubate the trachea after cessation of propofol was 15.1 (5.5) and 16.2 (6.1) min for children who had TCI and manual infusion, respectively (P=0.42). The mean propofol infusion rate was 16.7 [standard deviation (sd) 4.2] mg kg−1 h−1 in the TCI group and 14.6 (3.1) mg kg−1 h−1 in the manual infusion group (P=0.036). The percentage of time when BIS was >60 was significantly lower in the TCI than the manual infusion group [10.2% (18.4%) vs 23.2% (26.3%), P=0.016]. DiscussionUse of TCI led to higher propofol doses but not prolonged recovery time in children compared with manual infusion. It was associated with a greater percentage of time when the BIS was in the desired range and it may be an easier method for titration of propofol administration during anaesthesia or sedation. Clinical trial registrationChiCTR-IOD-16010147.

Cost-effectiveness of closed-loop versus open-loop infusion of propofol guided by bispectral index in elderly patients undergoing abdominal surgery

Objective To compare the cost-effectiveness of closed-loop versus open-loop infusion of propofol guided by bispectral index (BIS) in elderly patients undergoing abdominal surgery. Methods Sixty American Society of Anesthesiologists physical status Ⅱpatients of either sex, aged 65-75 yr, with body mass index of 18-25 kg/m2, undergoing elective open gastrointestinal tumor resection with general anesthesia, were allocated into closed-loop target-controlled infusion (TCI) group (group C) and open-loop TCI group (group O) using a random number table.Propofol was given using closed-loop TCI, and the target BIS value was set at 45-55 in group C. In group O, the target plasma concentration (2.0-3.5 μg/ml) of propofol was adjusted to maintain the BIS value at 45-55.Remifentanil was given by TCI with the target plasma concentration of 2-8 ng/ml in both groups.The total consumption of propofol and remifentanil, time rate of maintaining BIS value within the target range, development of intraoperative hypertension and hypotension, emergence time, tracheal extubation time, time for recovery of orientation, first ambulation time, time to first flatus and length of postoperative hospital stay were recorded.The development of nausea and vomiting and delirium within 3 days after operation and intraoperative awareness was recorded.The cost of anesthetics and total cost of anesthesia were calculated. Results Compared with group O, the total consumption of propofol was significantly decreased, the total consumption of remifentanil was increased, the time rate of maintaining BIS value within the target range was increased, the emergence time, tracheal extubation time and time for recovery of orientation were shortened, the cost of propofol and total cost of anesthesia were decreased (P 0.05). Intraoperative awareness was not found in two groups. Conclusion Compared with open-loop infusion of propofol guided by BIS, closed-loop infusion of propofol guided by BIS is a cost-effective method of anesthesia in elderly patients undergoing abdominal surgery. Key words: Drug delivery systems; Propofol; Electroencephalography; Cost-benefit analysis

Comparison of Different Analgesic Techniques for Pain Relief During Extracorporeal Shock Wave Lithotripsy: a Double-blind, Randomized Clinical Trial.

Background:Most patients experience some degree of pain during extracorporeal shock waves lithotripsy (ESWL).Aim:The aim of this study was to evaluate the effect of target-controlled infusion (TCI) of remifentanil or sufentanil and patient-controlled analgesia (PCA) with sufentanil or morphine for pain relief during ESWL.Materials and Methods:In a double blind, randomized clinical trial, a total of 60 patients who were scheduled for elective ESWL, randomly assigned into four groups (A, B, C and D). Patients in group A and B received remifentanil and sufentanil with TCI, respectively. Also, patients in group C and D received sufentanil and morphine with PCA, respectively. All patients in four groups were assessed about the intensity of their pain with Visual Analogue Scale (VAS) in three phases; the discharge of the waves (phase A), during breaking the stones (phase B) and the end of the procedure (phase C).Results:Patients in morphine PCA group experienced highest pain intensity in all stages, but patients in remifentanil TCI group experienced lowest pain intensity during lithotripsy. Remifentanil/TCI group experienced the lowest pain in B and C phases and the sufentanil/TCI group had the lowest pain only in the phase A. There was no significant difference in the occurrence of complications in all four groups.Conclusion:The current study demonstrates that efficacy of TCI pump in the reduction of pain during ESWL is superior to the PCA pump. Among the drugs that used in this study, remifentanil has more effective in pain management in the all phases during ESWL. We believe that using remifentanil/TCI should strongly be considered to clinicians in ESWL units.

Abstract PR244

Background & Objectives: Total intravenous anaesthesia (TIVA) with target controlled infusion (TCI) of propofol in children reduces emergence delirium, postoperative nausea and vomiting, laryngospasm and pain1. Despite this, it is not often used. One major criticism is prolonged recovery time 2. Since TCI obviates the need to manually adjust infusion rate, the use of TCI to deliver propofol in children may shorten recovery time and reduce propofol dose. The goal of this study was to determine whether TCI reduces time to extubation and recovery of consciousness after TIVA. Materials & Methods: Children with ASA 1, aged 1- 12 years undergoing surgery requiring endotracheal intubation were recruited and randomly assigned to TCI or manual propofol infusion. Children in the TCI group had propofol delivered by TCI using the Paedifusor PK model starting at 5 mcg.ml-1 at induction. Children for manual infusion had a loading dose of 2.5mg.kg-1, with subsequent infusion at 15-13-11-10-9 mg.kg.hr-1 3. Bispectral index™ was used to guide propofol dose. The attending anaesthesiologist adjusted the TCI or manual infusion as necessary according to maintain BIS between 40-60. Results: To date 62 children have been recruited and 59 have completed the study. There was no difference in extubation time, but the children in the TCI group had significantly longer time to eye opening and time to obeying commands (table 1). The TCI group had significantly more propofol. Remifentanil consumption between the two groups was similar (table 1).Table 1.: Value in mean+/-SD or Number (%)Conclusion: Discussion Use of TCI lead to higher propofol doses and prolonged recovery time in children compared to manual infusion.

Abstract PR603

Background & Objectives: Total intravenous anesthesia is an anesthetic technique that can be administered with TCI (target controlled infusion) or closed loop systems. The authors designed an automatic controlled system using fuzzy logic with clinical variables such Bispectral Index (BIS), heart rate and blood pressure. The aim of this study was to evaluate the clinical and technical performance of this controller compared with a conventional TCI system in patients who undergoing general surgery under anesthesia in an University Hospital, Medellin, Colombia. Materials & Methods: It was a controlled, randomized, single-blind study in which 150 surgical patients were assigned two groups: 75 patients were into TCI group and 75 patients were into closed loop with BIS. The clinical performance was determined according to the mean surgical time in range of BIS between 40-60. In addition, the proportion of patients with more than 80% of the surgical time with BIS between 40-60 (it was considered optimal), patients with adequate intra operative analgesia as measured by the analgoscore between -3 and +3. The technical performance of the controller was determined by MDPE, MDAPE, wobble. Results: For the primary outcome the mean time of BIS 40-60 for the closed loop group was 75.24% (SD 15.78) vs 59.5% (SD 20.3) for the TCI system, with an absolute difference of 15.8%, IC 95%: 9.9% to 21.65%, p <0.0001. The proportion of patients with more than 80% of surgical time with BIS 40-60 in closed-loop group was 48% vs 17.3% in TCI (RR 2.78, IC 1.60 - 4.78, p = 0.0001) (seefigure 1). The mean time for adequate intraoperative analgesia was 82.4% (SD 25.1) for closed loop and 70.77% (SD 32.8) in TCI, with an absolute difference of 4.76, IC 95%: 2.23 to 21.06, p = 0.016. The technical performance for closed loop controller was better than TCI systems (MDPE -11,05 vs -3,33, p=0,0001; MDAPE 15,57 vs 11,47, p = 0,0001). There was no difference in the proportion of awakening or intra operative movement. No intraoperative recall episodes was reported.Conclusion: The closed-loop system was better than a TCI system to maintain BIS between 40-60 during a general anesthetic.

The administration of high-dose propofol sedation with manual and target-controlled infusion in children undergoing radiation therapy: a 7-year clinical investigation.

BackgroundRadiation therapy requires the patient to remain immobile for a long time, which is challenging in children. This study therefore aimed to determine the adequate target concentration and dosage of propofol in target-controlled infusion (TCI) and manual infusion (MI) in children requiring sedation for proton radiation therapy. Our hypothesis is that the adequate dose of propofol sedation required for proton radiation therapy in pediatric patients was larger than that seen in previous studies.MethodsWe retrospectively analyzed the medical records of Korean children who received proton therapy under propofol sedation. The average target concentration at induction and during maintenance with TCI and the dose with MI were analyzed as primary outcomes.ResultsA total of 1296 procedures in 54 children were analyzed (TCI group, 26; MI group, 28). The median bolus dose of propofol in the MI group was 2.6 (2.2–3.0) mg/kg, while the pump speed was 17.0 (13.6–25.8) mg/kg/h. The median target concentration of propofol in the TCI group was 5.3 (4.4–5.7) mcg/mL at induction and 4.2 (3.1–5.1) mcg/mL during maintenance. There were no cases of life-threatening complications in either group over 7 years. There were six cases of transient desaturation, which were managed by using the jaw thrust maneuver.ConclusionsCompared with those in previous studies, the target concentration of propofol with TCI and the propofol dose with MI required for adequate sedation in children undergoing proton radiation therapy were larger in the present study. Despite concerns regarding overdosage, the complications were managed well. However, safe and adequate sedation for proton radiation therapy remains a challenge. The development of monitoring tools to evaluate the depth of sedation is necessary to adjust the propofol dose and sedation level.

Target-Controlled Infusion of Propofol in Training Anesthesiology Residents in Colonoscopy Sedation: A Prospective Randomized Crossover Trial.

BackgroundPropofol is widely used in sedation for colonoscopy, but its adverse effects on cardiovascular and respiratory systems are still concerning. The present study investigated whether target controlled infusion (TCI) of propofol could provide a better sedation quality than manually controlled infusion (MCI) in training inexperienced anesthesiology residents.Material/MethodsEighteen training residents were allocated into 2 groups receiving TCI and MCI training in their first month in the endoscopy center, while receiving MCI and TCI training instead in their second month. The last 2 patients at the end of each month were included to analyze the sedation quality of TCI and MCI techniques by comparing satisfaction of endoscopist and patients based on the visual analogue scale (VAS). Heart rate (HR), mean blood pressure (MAP), SpO2, and recovery time were also compared as the secondary outcomes.ResultsThe demographic data were similarly distributed among the TCI and MCI patients. Endoscopist’s satisfaction score in the TCI group was significantly higher than in the MCI group, 81.3±7.2 versus 74.2±9.5 (P=0.003), but the patients’ satisfaction score was similar between the 2 groups. More stable hemodynamic status was obtained in the TCI group, manifested as higher lowest MAP and lower highest MAP than in the MCI group. Lowest SpO2 in the TCI group was significantly higher than in the MCI group. Patients in the TCI group recovered earlier than in the MCI group.ConclusionsTCI is a more effective and safer technique for anesthesiology residents in sedation for colonoscopy.

Manual versus target-controlled infusion of balanced propofol during diagnostic colonoscopy: A prospective randomized controlled trial

There is an increasing interest in balanced propofol sedation (BPS) for colonoscopy in outpatient settings. Propofol is a potent anesthetic agent for this purpose and has a narrow therapeutic range, which increases a risk of cardiovascular and respiratory complications in case of improper administration. The aim of this study was to compare patients’ safety and comfort of endoscopists in two methods of BPS targeting deep sedation – propofol target-controlled infusion (TCI) and manual intravenous titration technique (MT) – during colonoscopy. This prospective randomized controlled trial included 90 patients (class I or II of the American Society of Anesthesiologists) deeply sedated with propofol, coadministered with small doses of midazolam and fentanyl. Propofol was given by MT technique (45 patients) or by TCI (45 patients). The following adverse effects were recorded: hypotension, hypertension, bradycardia, tachycardia, hypoxemia, bradypnea, apnea, hiccupping, and coughing, as well as endoscopist’s comfort during colonoscopy by means of a questionnaire. The MT group compared to the TCI group had a lower mean arterial pressure in the 10th minute after the beginning (p = 0.017), and at the end of colonoscopy (p = 0.006), higher oxygen saturation in the fifth minute (p = 0.033), and in the 15th minute (p = 0.008) after the beginning of colonoscopy, and lower heart rate at the beginning of the procedure (p = 0.001). There were no statistically significant differences in adverse events. Endoscopist’s comfort during colonoscopy was high 95.6% in the TCI group vs. 88.9% in the MT group (p = 0.069). MT is clinically as stable as TCI of propofol for deep sedation during colonoscopy, and endoscopists experienced the same comfort during colonoscopy in both groups. Thus, both combinations are suitable for deep sedation during diagnostic colonoscopy.

Sedation for gastrointestinal endoscopy with the application of target-controlled infusion.

A majority of esophagogastroduodenoscopy (EGD) and colonoscopy procedures are performed under sedation, with the intravenous administration of a hypnotic agent combined with an opioid analgesic agent. The goal of our study was to establish the quality and plausibility of target-controlled infusion (TCI) as a sedation mechanism for upper and lower gastrointestinal (GI) endoscopies. A randomized, single-blinded, controlled clinical trial was arranged in a local community hospital. In total, 100 adult outpatients scheduled for upper and lower GI endoscopies were included and randomly allocated to a control group (n=50) and a TCI group (n=50). The sedation quality was assessed using the simplified quality of an anesthesia scoring system. Categorical parameters were compared using Pearson's chi-square test. Continuous parameters that were normally distributed were further compared using Student's t-test, and the others were compared using the Mann-Whitney test. The significantly lower anesthesia quality score in the TCI group (12.2 vs. 12.7) indicated that the anesthesia quality was better in this group. This study showed that sedation using TCI for GI endoscopy provided safe and effective sedation and was associated with a better sedation quality. We believe that TCI can be used to provide routine sedation for patients receiving GI endoscopy.

Comparison between Intermittent Propofol Bolus Techniques and Target-Controlled Infusion in Patients Underwent Gastrointestinal Endoscopy

Background : Nowadays, the use of propofol for sedation during gastrointestinal endoscopic procedure has become more popular, either by intermittent-bolus (IB) technique or target-controlled infusion (TCI). The aim of this study was to compare the outcomes of both techniques including the total consumption of propofol, consumption per minute, total cost, side effects and its recovery time. Method : This study was a single-blinded randomized clinical trial conducted at Digestive Endoscopy Center, Cipto Mangunkusumo Hospital, Jakarta between October and November 2013. There were fifty patients with pre-operative American Society of Anesthesiologist (ASA) Physical Status Classification I-III, aged 18-65 years, body mass index 18-30 kg/m2 who were randomized to obtain sedation with IB propofol or TCI after having a premedication with 1 μg/kgBW fentanyl. The outcomes including the duration of sedation, total dose, propofol consumption per minute, the total cost, the incidence of hypotension, the incidence of desaturation, and recovery time were then evaluated using SPSS version 21.0. Results : Duration of procedure between two groups was not significantly different (p = 0.718). Total dose of propofol, its consumption per minute and total cost were higher in TCI group (p = 0.010; p = 0.004; p = 0.001). The incidence of hypotension, desaturation and recovery time were not  significantly different (p = 0.248; p = 0.609; p = 0.33) in both groups. Conclusion : IB technique is more efficient in terms of total propofol dose, consumption per minute and total cost compared to the TCI technique. The incidences of hypotension, desaturation and recovery time profiles were comparable between the two groups. Keywords: gastrointestinal endoscopy, intermittent bolus, propofol, sedation, TCI