[Total intravenous anesthesia based on propofol infusion with target concentration: a new procedural solution]

Area of Science:

• Anesthesiology
• Neuroscience
• Pharmacology

Context:

• Total intravenous anesthesia (TIVA) with propofol target-controlled infusion (TCI) is widely used in surgical settings.
• Monitoring anesthetic depth and patient response is crucial for safe and effective anesthesia delivery.
• Understanding the relationship between propofol concentration and electroencephalogram (EEG) changes is essential for optimizing TCI protocols.

Purpose:

• To investigate the correlation between propofol concentration at awakening and at the onset of sleep in patients undergoing TCI anesthesia.
• To evaluate the impact of propofol TCI on hemodynamic stability and EEG spectral characteristics.
• To establish guidelines for propofol TCI anesthesia based on effective concentration (Ce) and EEG parameters.

Summary:

• A study involving 61 surgical patients (ASAI-II) utilized propofol TCI.
• A high correlation (r = 0.64) was observed between propofol concentration in the central compartment at awakening and the effective concentration (Ce) at the start of anesthesia.
• Model investigation suggested longer induction periods minimize hemodynamic disturbances. Propofol TCI at 2 µg/mL altered EEG spectral potency (1-12 Hz), induced biomodality, and decreased right-side frequency.

Impact:

• The findings provide a basis for determining propofol TCI anesthesia policies by utilizing Ce values at loss of consciousness and specific EEG spectral frequencies.
• This research contributes to optimizing propofol TCI administration for improved patient safety and anesthetic management.
• Understanding the relationship between propofol levels and EEG can lead to more precise anesthetic titration and reduced adverse events.