Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-26T05:26:02.035Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of a target-controlled infusion system for propofol does not improve subjective assessment of anaesthetic depth by inexperienced anaesthesiologists*

Published online by Cambridge University Press:  01 November 2007

B. Rehberg ,
C. Ryll ,
D. Hadzidiakos  and
J. Baars
B. Rehberg*
Affiliation:
Charité-Universitätsmedizin Berlin, Campus Mitte, Klinik für Anästhesiologie und operative Intensivmedizin, Berlin, Germany
C. Ryll
Affiliation:
Charité-Universitätsmedizin Berlin, Campus Mitte, Klinik für Anästhesiologie und operative Intensivmedizin, Berlin, Germany
D. Hadzidiakos
Affiliation:
Charité-Universitätsmedizin Berlin, Campus Mitte, Klinik für Anästhesiologie und operative Intensivmedizin, Berlin, Germany
J. Baars
Affiliation:
Charité-Universitätsmedizin Berlin, Campus Mitte, Klinik für Anästhesiologie und operative Intensivmedizin, Berlin, Germany
*
Correspondence to: Benno Rehberg, Charité-Universitätsmedizin Berlin, Campus Mitte, Klinik für Anästhesiologie und operative Intensivmedizin, Schumannstr. 20/21, Berlin 10117, Germany E-mail: benno.rehberg@charite.de; Tel: +49 (0)30450531227; Fax: +49 (0)30450531927
Get access

Summary

Background and objectives

Target-controlled infusion, via the calculated effect compartment concentrations, may help anaesthesiologists to titrate anaesthetic depth and to shorten recovery from anaesthesia.

Methods

In this prospective, randomized clinical study, we compared the performance of six inexperienced anaesthesiologists with <1 yr of training when using target- or manually controlled infusion of propofol, combined with manual dosing of fentanyl. Ninety-two premedicated ASA I–III patients undergoing minor elective urological or gynaecological surgery were assigned to the manual- or target-controlled infusion group. Bispectral index was recorded in a blinded manner. Subjective assessment of anaesthetic depth on a 10 point numerical scale (1 = very deep anaesthesia, 10 = awake) was asked at regular intervals and the correlation with the blinded bispectral index was analysed using the prediction probability, PK. The propofol concentration profile was calculated post hoc.

Results

Propofol administration was similar in both groups with no significant difference for the administered amount and concentrations of propofol. Recovery times were also not different. In both groups, a large percentage of the bispectral index data points recorded during surgery showed bispectral index values below the recommended value of 40, but in the target-controlled infusion group there were significantly less bispectral index values above the recommended upper limit of 60 (2.5% vs. 5.1%).

Conclusions

A target-controlled infusion system does not help inexperienced anaesthesiologists to assess anaesthetic depth or to shorten recovery times, but may reduce episodes of overly light anaesthesia and thus help to prevent awareness.

Keywords

ANAESTHESIA INTRAVENOUSPROPOFOLELECTROENCEPHALOGRAPHY, bispectral index, depth of anaesthesia
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 11 , November 2007 , pp. 920 - 926
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

This paper was presented in part at the ‘Hauptstadtkongress für Anaesthesie und Intensivmedizin’, 2006 April 6–8, Berlin (Germany).

References

1.Hadzidiakos, D, Nowak, A, Laudahn, N, Baars, J, Herold, K, Rehberg, B. Subjective assessment of depth of anaesthesia by experienced and inexperienced anaesthetists. Eur J Anaesthesiol 2006: 1–8.Google Scholar
2.Servin, FS. TCI compared with manually controlled infusion of propofol: a multicentre study. Anaesthesia 1998; 53 (Suppl 1): 82–86.CrossRefGoogle ScholarPubMed
3.Ecoffey, C, Viviand, X, Billard, V et al. . Target controlled infusion (TCI) anesthesia using propofol. Assessment of training and practice in the operating room. Ann Fr Anesth Reanim 2001; 20: 228–245.Google ScholarPubMed
4.Passot, S, Servin, F, Allary, R et al. . Target-controlled versus manually-controlled infusion of propofol for direct laryngoscopy and bronchoscopy. Anesth Analg 2002; 94: 1212–1216, table.Google Scholar
5.Passot, S, Servin, F, Pascal, J, Charret, F, Auboyer, C, Molliex, S. A comparison of target- and manually controlled infusion propofol and etomidate/desflurane anesthesia in elderly patients undergoing hip fracture surgery. Anesth Analg 2005; 100: 1338–1342, table.CrossRefGoogle ScholarPubMed
6.Russell, D, Wilkes, MP, Hunter, SC, Glen, JB, Hutton, P, Kenny, GN. Manual compared with target-controlled infusion of propofol. Br J Anaesth 1995; 75: 562–566.CrossRefGoogle ScholarPubMed
7.Hu, C, Horstman, DJ, Shafer, SL. Variability of target-controlled infusion is less than the variability after bolus injection. Anesthesiology 2005; 102: 639–645.CrossRefGoogle Scholar
8.Schnider, TW, Minto, CF, Gambus, PL et al. . The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology 1998; 88: 1170–1182.CrossRefGoogle ScholarPubMed
9.Schnider, TW, Minto, CF, Shafer, SL et al. . The influence of age on propofol pharmacodynamics. Anesthesiology 1999; 90: 1502–1516.CrossRefGoogle ScholarPubMed
10.Smith, WD, Dutton, RC, Smith, NT. Measuring the performance of anesthetic depth indicators. Anesthesiology 1996; 84: 38–51.CrossRefGoogle ScholarPubMed
11.Shafer, SL, Varvel, JR, Aziz, N, Scott, JC. Pharmacokinetics of fentanyl administered by computer-controlled infusion pump. Anesthesiology 1990; 73: 1091–1102.CrossRefGoogle ScholarPubMed
12.Breslin, DS, Mirakhur, RK, Reid, JE, Kyle, A. Manual versus target-controlled infusions of propofol. Anaesthesia 2004; 59: 1059–1063.CrossRefGoogle ScholarPubMed
13.Struys, M, Versichelen, L, Rolly, G. Propofol target-controlled infusion in clinical practice. Acta Anaesthesiol Belg 1997; 48: 207–211.Google ScholarPubMed
14.Glass, PS, Bloom, M, Kearse, L, Rosow, C, Sebel, P, Manberg, P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836–847.CrossRefGoogle ScholarPubMed
15.Iselin-Chaves, IA, Willems, SJ, Jermann, FC, Forster, A, Adam, SR, Van der, LM. Investigation of implicit memory during isoflurane anesthesia for elective surgery using the process dissociation procedure. Anesthesiology 2005; 103: 925–933.CrossRefGoogle ScholarPubMed
16.Monk, TG, Saini, V, Weldon, BC, Sigl, JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg 2005; 100: 4–10.CrossRefGoogle ScholarPubMed
17.Drummond, JC, Patel, PM. Editorial Board reproached for publication of BIS-mortality correlation. Anesth Analg 2005; 101: 1238–1239.CrossRefGoogle Scholar