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[Propofol administration systems. Handling, hemodynamics and propofol consumption].

J G Triem¹, K D Röhm, J Boldt

¹Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Ludwigshafen gGmbH, Ludwigshafen. triemj@klilu.de

Der Anaesthesist

|February 4, 2009

Summary

Target-controlled infusion (TCI) systems for propofol administration are safe and cost-effective for extended anesthesia procedures compared to manual controlled infusion (MCI). Both TCI methods reduced propofol consumption, leading to potential cost savings.

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Area of Science:

Anesthesiology
Pharmacokinetics
Medical Technology

Background:

Propofol is commonly administered via manual controlled infusion (MCI) or target-controlled infusion (TCI) during anesthesia.
Evaluating different TCI systems against MCI is crucial for optimizing anesthetic delivery, patient safety, and cost-effectiveness.

Purpose of the Study:

To compare two distinct TCI systems (Schnider and Marsh models) with the MCI technique for propofol administration.
To assess handling, patient safety, and cost implications of TCI versus MCI.

Main Methods:

A prospective study involving 90 patients undergoing elective nasal surgery, randomly assigned to TCI-Schnider, TCI-Marsh, or MCI groups (n=30 each).
Anesthesia depth was monitored using the bispectral index (BIS) adjusted to 40-55.
Data collected included hemodynamics, extubation/awakening times, dose adjustments, drug consumption, costs, recovery quality, PONV, shivering, and patient satisfaction.

Main Results:

No significant differences in demographics, hemodynamics, or initial propofol consumption (first 60 min) were observed.
Both TCI groups showed significantly lower propofol consumption during extended anesthesia (>60 min) compared to MCI.
The TCI-Schnider group exhibited fewer episodes of bradycardia; dose adjustment needs did not differ significantly between TCI groups.

Conclusions:

Propofol administration via MCI or TCI under BIS monitoring is safe and manageable.
TCI techniques result in reduced propofol consumption and potential cost savings for anesthesia procedures exceeding 60 minutes.
No significant differences in extubation or awakening times were found between the methods.