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The Safety of Target-Controlled Infusions
Thomas W Schnider1, Charles F Minto, Michel M R F Struys
1From the *Department of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, Switzerland; †University of Berne, Bern, Switzerland; ‡Department of Anaesthesia, North Shore Private Hospital, Hunters Hill Private Hospital, Westmead Private Hospital, Sydney Adventist Hospital, Sydney, Australia; §Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and ‖Department of Anesthesia, Ghent University, Ghent, Belgium.
Target-controlled infusion (TCI) technology in anesthesia is safe for clinical use. After two decades, TCI shows no unique safety issues compared to traditional methods, with risks similar to selecting the wrong drug.
Area of Science:
- Anesthesiology
- Pharmacokinetics
- Medical Device Technology
Background:
- Target-controlled infusion (TCI) uses pharmacokinetic models for precise anesthetic drug delivery.
- TCI is computationally complex, adjusting infusion rates for drug uptake into body compartments.
- Concerns exist regarding unique safety issues with TCI for intravenous anesthetics.
Purpose of the Study:
- To assess the safety of Target-controlled infusion (TCI) technology after two decades of clinical use.
- To identify and describe safety-relevant issues associated with TCI in anesthesia.
- To evaluate if TCI introduces unique safety concerns compared to conventional infusion methods.
Main Methods:
- Literature review of published medical studies.
- Analysis of information from TCI manufacturers.
- Examination of publicly available governmental safety data.
Main Results:
- No data indicate that TCI introduces unique safety issues beyond the risk of selecting an incorrect pharmacokinetic model.
- Human errors in IV anesthesia setup are documented but not unique to TCI.
- TCI safety is comparable to constant rate infusions for anesthetic administration.
Conclusions:
- Target-controlled infusion (TCI) technology is at least as safe as constant rate infusions.
- The primary safety risk with TCI is selecting the wrong pharmacokinetic model, similar to other infusion pump risks.
- Extensive clinical use has not revealed unique safety concerns inherent to TCI drug delivery.
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