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High initial target blood concentration in target-controlled infusion: A randomized controlled trial.

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Higher initial propofol target blood concentrations (TBC) using target-controlled infusion (TCI) significantly reduced induction time for intravenous sedation (IVS). An initial TBC of 2.6 μg/ml proved acceptable for moderate sedation, despite a larger discrepancy.

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conscious sedationinfusion pumppharmacokineticspropofol

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Area of Science:

  • Anesthesiology
  • Pharmacology

Background:

  • Propofol intravenous sedation (IVS) with target-controlled infusion (TCI) utilizes target blood concentration (TBC) for precise drug delivery.
  • Previously established methods with an initial TBC of 2.2 μg/ml allow prediction of optimal intraoperative TBC during induction.

Purpose of the Study:

  • To evaluate the efficacy of higher initial TBCs in reducing induction time for propofol IVS.
  • To determine if the modified TCI method is clinically useful with elevated initial TBCs.

Main Methods:

  • Forty-five patients undergoing oral surgery were randomized into three groups with initial TBCs of 2.2, 2.6, or 3.0 μg/ml.
  • The TCI pump was reset to the calculated brain concentration once target sedation was achieved.
  • Manual adjustments maintained moderate sedation based on clinical signs and bispectral index, comparing maximum TBC discrepancy and induction time.

Main Results:

  • Induction times were significantly shorter in groups with higher initial TBCs (2.6 and 3.0 μg/ml) compared to the 2.2 μg/ml group.
  • Group 3 (3.0 μg/ml) showed a larger maximum TBC discrepancy (1.0 ± 1.3 μg/ml) than Group 1 (0.5 ± 0.3 μg/ml).
  • Group 2 (2.6 μg/ml) had a significant reduction in induction time (135 ± 33 min) with a moderate discrepancy (0.8 ± 0.2 μg/ml).

Conclusions:

  • Using an initial TBC of 2.6 μg/ml with the modified TCI method significantly shortens propofol IVS induction time.
  • This approach may be clinically acceptable for achieving moderate sedation, balancing reduced induction time with acceptable TBC discrepancies.