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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.

Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference
|January 24, 2009
PubMed

Insights

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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