Individual titration of propofol plasma target improves anaesthetic stability in patients undergoing major abdominal surgery: a comparison with manually controlled infusion.
OBJECTIVE
The impact of anaesthesia using target-controlled infusion with propofol on intraoperative stability, recovery and cost compared to manually controlled infusion has been evaluated with inconsistent results. We studied a new device that allows more individual titration of propofol target-controlled infusion by using the effect-site concentration at the loss of eyelash reflex to predict the maintenance infusion rate (FM-TCI).


METHODS
Fifty-six patients undergoing major abdominal surgery lasting >2 h were randomly assigned to receive either FM-TCI (n = 28) or MCI-controlled (n = 28) anaesthesia. Both groups were Bispectral Index-monitored and thoracic epidural analgesia was established. Anaesthetic stability, incidence of haemodynamic abnormalities, time to extubation, propofol consumption and patient satisfaction were assessed.


RESULTS
In the FM-TCI group, a significantly improved anaesthetic stability was achieved (0.43 +/- 0.44 vs. 1.31 +/- 0.78 adjustments of propofol infusion per patient per hour, P = 0.003) and time to extubation was significantly shorter (9.6 +/- 2.1 vs. 15.7 +/- 9.6 min P = 0.011). With FM-TCI, propofol consumption was significantly lower. Haemodynamic stability and patient satisfaction did not differ between the groups.


CONCLUSIONS
FM-TCI helps to provide more stable anaesthesia conditions requiring less-frequent adjustments of the propofol infusion compared to manually controlled infusion in patients undergoing major abdominal surgery.
Mayer
J
J
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany. j-mayer@gmx.de
Boldt
J
J
Triem
J G
JG
Schellhaass
A
A
Mengistu
A M
AM
Suttner
S
S
D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000771:Anesthesia, Intravenous / Q000295:instrumentation / Q000379:methods; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D013505:Digestive System Surgical Procedures; D016503:Drug Delivery Systems / Q000295:instrumentation* / Q000379:methods; D004569:Electroencephalography / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage* / Q000097:blood; D017186:Titrimetry / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D015742:Propofol