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Comparison of total intravenous anesthesia (TIVA) to target-controlled infusion (TCI). A, Illustration of infusion rates (top plots), predicted effect-site
concentrations (Ce, second row of plots), and selected predicted effects (bottom plots) comparing TIVA and TCI using propofol and remifentanil. The TIVA
technique included an induction dose of 2-mg/kg propofol (not shown on the top left plot) followed by continuous infusions of propofol 100 mcg/kg/min and
remifentanil 0.2 mcg/kg/min. The TCI technique consisted of a target propofol effect-site concentration (Ce) of 3 mcg/mL and a target remifentanil Ce of 6
ng/mL.
B, Comparison
of changes
in infusion
versus targetofCe
levels for aClinical
continuous
1-hour propofol
infusion. In this simulation, there were 4 changes in
Source:
Considerations
for rate
the Maintenance
Anesthesia,
Pharmacology
for Anesthesiology
drug administration. For the TIVA (pink line), there were (1) a 1-mg/kg bolus followed by an infusion of 100 mcg/kg/min, (2) a change in the infusion rate to
Citation: Johnson KB. Clinical Pharmacology for Anesthesiology; 2015 Available at: http://mhmedical.com/ Accessed: May 14, 2017
150 mcg/kg/min, (3) a change in the infusion rate to 50 mcg/kg/min, and (4) the infusion was turned off. For the TCI (blue line), there were (1) a change
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from a target Ce of 0 to 2.3 mcg/mL, (2) a change from 2.3 to 3.4 mcg/mL, (3) a change from 3.4 to 1.6 mcg/mL, and (4) a change from 1.6 to 0 mcg/mL.
The target Ce levels were selected to be similar to the concentrations achieved with the continuous infusion rates after 20 minutes. This figure illustrates a
key advantage of administering propofol via TCI. TCI can achieve and maintain a target concentration faster than a change in a continuous infusion. This