Practicalities of Total Intravenous Anesthesia and Target-controlled Infusion in Children

Area of Science:

• Anesthesiology
• Pharmacokinetics
• Pediatric Critical Care

Background:

• Total intravenous anesthesia (TIVA) in children commonly employs propofol and remifentanil.
• Target-controlled infusion (TCI) systems offer precise drug delivery by targeting plasma or effect-site concentrations.
• Pharmacokinetic models are essential for accurate TCI drug administration.

Purpose of the Study:

• To review the application and parameters of target-controlled infusion (TCI) for propofol and remifentanil in pediatric anesthesia.
• To highlight the importance of pharmacokinetic parameter sets in optimizing TCI delivery for children.
• To discuss factors influencing recommended drug concentrations and adjunct monitoring.

Main Methods:

• Review of existing pharmacokinetic parameter sets for propofol (Absalom, Kataria) and remifentanil (Minto) in pediatric TCI.
• Discussion of the role of the linking rate constant (keo) in estimating effect-site concentration.
• Consideration of clinical factors affecting target concentration selection.

Main Results:

• Established pharmacokinetic parameter sets (Absalom, Kataria for propofol; Minto for remifentanil) are generally satisfactory for pediatric TCI.
• Recommended target concentrations vary based on surgical factors, local anesthesia, and patient ventilation.
• Processed electroencephalographic monitoring aids TIVA and TCI, especially with neuromuscular blockade.

Conclusions:

• Pediatric TCI with propofol and remifentanil relies on validated pharmacokinetic models.
• Individualized target concentrations and advanced monitoring enhance anesthetic safety and efficacy in children.
• TCI systems, when programmed with appropriate parameters, provide reliable anesthesia for pediatric surgical procedures.