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Target controlled infusion for kids: trials and simulations
Disha Mehta1, Jon McCormack, Parry Fung
1Dept. of Anesthesiology, Pharmacology&Therapeutics, The Univ. of British Columbia, Vancouver, CANADA.
Target controlled infusion (TCI) for Kids accurately delivers propofol for pediatric anesthesia. While effect-site concentration (Ce) and state entropy (SE) did not reliably predict wake-up times, a Ce of 1.9 µg/ml best indicated emergence.
Area of Science:
- Anesthesiology
- Pharmacokinetics
- Pediatric Medicine
Background:
- Target controlled infusion (TCI) systems optimize drug delivery for anesthesia.
- Propofol is a common anesthetic agent requiring precise administration.
- Pediatric anesthesia presents unique pharmacokinetic challenges.
Purpose of the Study:
- To evaluate the design and performance of the TCI for Kids system.
- To assess the accuracy of propofol delivery and wake-up time prediction in children.
- To investigate the correlation between effect-site concentration (Ce), state entropy (SE), and emergence from anesthesia.
Main Methods:
- Preclinical validation of TCI for Kids software (Labview, Matlab) and drug delivery volume.
- Clinical pilot study involving 30 pediatric surgical procedures (3 months to 9 years).
- Simulation of propofol pharmacokinetics, assessment of predicted C(e) and wake-up times, and correlation with SE.
Main Results:
- TCI for Kids software implementations showed convergent validity; drug delivery accuracy was within clinically acceptable ranges (mean error 0.08 ± 0.01 ml).
- Neither C(e) nor SE reliably predicted wake-up times in pediatric patients.
- A C(e) of 1.9 µg/ml was identified as the optimal predictor for emergence from anesthesia in children.
Conclusions:
- The TCI for Kids system demonstrates accurate propofol delivery for pediatric anesthesia.
- Further research is needed to refine wake-up time prediction models in children due to inter-individual variability.
- Establishing optimal C(e) targets is crucial for managing anesthetic emergence in pediatric populations.
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