title: How to control propofol infusion in pediatric patients undergoing gamma knife radiosurgery.
abstract: BACKGROUND
  Although Gamma Knife radiosurgery (GKS) is commonly performed under local anesthesia, general anesthesia is sometimes required. The authors previously reported a remote-controlled patient management system consisting of propofol-based general anesthesia with a target-controlled infusion (TCI) that we designed for pediatric GKS. However, a commercially available propofol TCI system has age and weight limitations (<16 years and <30 kg). We examined a manually controlled regimen of propofol appropriate for pediatric GKS.
  
  
  METHODS
  A pharmacokinetic model of the TIVA Trainer© with Paedfusor's parameter was used. A manually controlled infusion scheme to achieve a sufficient level of propofol for pediatric GKS was examined in five models ranging from 10 to 30 kg.
  
  
  RESULTS
  Following a loading dose of 3.0 mg/kg, the combination of continuous infusion of 14, 12, 10, and 8 mg/kg/h resulted in a target concentration of 3.0-4.0 μg/ml, the required level for pediatric GKS.
  
  
  CONCLUSIONS
  Propofol titration is a key issue in GKS. Manual infusion is less accurate than TCI, but the combination of a small bolus and continuous infusion might be a substitute. Considering the characteristics of propofol pharmacokinetics in children, co-administration of opioids is recommended.
authors: Department of Anesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. macaroon@nifty.com
authors: Kotoe
authors: K
authors: Kamata
authors: Motohiro
authors: M
authors: Hayashi
authors: Yoshihiro
authors: Y
authors: Muragaki
authors: Hiroshi
authors: H
authors: Iseki
authors: Yoshikazu
authors: Y
authors: Okada
authors: Makoto
authors: M
authors: Ozaki
mesh_terms: D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000493:pharmacokinetics; D001165:Arteriovenous Malformations / Q000188:drug therapy / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000188:drug therapy / Q000601:surgery; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy / Q000601:surgery; D015742:Propofol / Q000008:administration & dosage* / Q000493:pharmacokinetics; D016634:Radiosurgery / Q000379:methods
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol