title: The Safety of Target-Controlled Infusions.
abstract: Target-controlled infusion (TCI) technology has been available in most countries worldwide for clinical use in anesthesia for approximately 2 decades. This infusion mode uses pharmacokinetic models to calculate infusion rates necessary to reach and maintain the desired drug concentration. TCI is computationally more complex than traditional modes of drug administration. The primary difference between TCI and conventional infusions is that TCI decreases the infusion rate at regular intervals to account for the uptake of drug into saturable compartments. Although the calculated infusion rates are consistent with manually controlled infusion rates, there are concerns that TCI administration of IV anesthetics could introduce unique safety concerns. After approximately 2 decades of clinical use, it is appropriate to assess the safety of TCI. Our aim in this article was to describe safety-relevant issues related to TCI, which should have emerged after its use in millions of patients. We collected information from published medical literature, TCI manufacturers, and publicly available governmental Web sites to find evidence of safety issues with the clinical use of TCI. Although many case reports emphasize that IV anesthesia is technically more demanding than inhaled anesthesia, including human errors associated with setting up IV infusions, no data suggest that a TCI mode of drug delivery introduces unique safety issues other than selecting the wrong pharmacokinetic model. This is analogous to the risk of selecting the wrong drug with current infusion pumps. We found no evidence that TCI is not at least as safe as anesthetic administration using constant rate infusions.
authors.affiliation: From the *Department of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, Switzerland; †University of Berne, Bern, Switzerland; ‡Department of Anaesthesia, North Shore Private Hospital, Hunters Hill Private Hospital, Westmead Private Hospital, Sydney Adventist Hospital, Sydney, Australia; §Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and ‖Department of Anesthesia, Ghent University, Ghent, Belgium.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Schnider
authors.forename: Charles F
authors.initials: CF
authors.lastname: Minto
authors.forename: Michel M R F
authors.initials: MM
authors.lastname: Struys
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Absalom
mesh_terms: D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics; D003243:Consciousness / Q000187:drug effects*; D004059:Diffusion of Innovation; D016503:Drug Delivery Systems / Q000295:instrumentation; D054796:Drug Dosage Calculations; D016903:Drug Monitoring; D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood / Q000493:pharmacokinetics; D007262:Infusions, Intravenous; D008508:Medication Errors / Q000517:prevention & control*; D008954:Models, Biological; D016343:Monitoring, Intraoperative; D061214:Patient Safety; D018570:Risk Assessment; D012307:Risk Factors; D012984:Software
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives