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Chapter 3 - TCI and TIVA: What a Good Idea!

Published online by Cambridge University Press:  18 November 2019

By
Michael G. Irwin  and
Gavin N. C. Kenny
Edited by
Michael G. Irwin ,
Gordon T. C. Wong  and
Shuk Wan Lam
Michael G. Irwin
Affiliation:
The University of Hong Kong
Gordon T. C. Wong
Affiliation:
The University of Hong Kong
Shuk Wan Lam
Affiliation:
The University of Hong Kong
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Summary

The introduction of TCI pumps into clinical practice invoked a sense of interest, and a sense of reservation stemming from the concern of getting the dose wrong and causing awareness. I experienced the frustration of not grasping all of the intricacies of the complicated pharmacokinetics. I experienced the annoyance of delayed emergence from getting the dose wrong from both TCI and manual infusions. There was only the rare TIVA enthusiast who could explain aspects of this dark art. Therefore like a lot of my colleagues I did not bother too much with using TIVA except for neurosurgery or for those with a history of severe PONV. It just felt like too much of a nuisance for not much gain.

Type
Chapter
Information
Taking on TIVA
Debunking Myths and Dispelling Misunderstandings
 , pp. 14 - 21
Publisher: Cambridge University Press
Print publication year: 2019

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References

Kenny, G.N.C., White, M.. A portable computerised infusion system for propofol. Anaesthesia 1990; 45: 692–3.CrossRefGoogle ScholarPubMed
Gray, J.M., Kenny, G.N.C.. Development of the technology for ‘Diprifusor’ TCI systems. Anaesthesia 1998; 53: 22–7.CrossRefGoogle ScholarPubMed
Schüttler, J., Kloos, S., Schwilden, H., Stoeckel, H.. Total intravenous anaesthesia with propofol and alfentanil by computer-assisted infusion. Anaesthesia 1988; 43: 2–7.Google Scholar
Glass, P.S.A., Jacobs, J.R., Richard Smith, L., et al. Pharmacokinetic model-driven infusion of fentanyl: assessment of accuracy. Anesthesiology 1990; 73: 1082–90.CrossRefGoogle ScholarPubMed
Glass, P.S., Glen, J.B., Kenny, G.N., Schuttler, J., Shafer, S.L.. Nomenclature for computer-assisted infusion devices. Anesthesiology 1997; 86: 1430–1.Google Scholar
Frei, F.J., Zbinden, A.M., Thomson, D.A., Rieder, H.U.. Is the end-tidal partial pressure of isoflurane a good predictor of its arterial partial pressure? Br J Anaesth 1991; 66: 331–9.Google Scholar
Landon, M.J., Matson, A.M., Royston, B.D., Hewlett, A.M., White, D.C., Nunn, J.F.. Components of the inspiratory-arterial isoflurane partial pressure difference. Br J Anaesth 1993; 70: 605–11.Google Scholar
Glen, J.B., White, M.. A comparison of the predictive performance of three pharmacokinetic models for propofol using measured values obtained during target-controlled infusion. Anaesthesia 2014; 69: 550–7.CrossRefGoogle ScholarPubMed
Marsh, B., White, M., Morton, N., Kenny, G.N.. Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth 1991; 67: 41–8.Google Scholar
Schnider, T.W., Minto, C.F., Gambus, P.L., et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology 1998; 88: 1170–82.Google Scholar
Schnider, T.W., Minto, C.F., Shafer, S.L., et al. The influence of age on propofol pharmacodynamics. Anesthesiology 1999; 90: 1502–16.CrossRefGoogle ScholarPubMed
Absalom, A.R., Mani, V., De Smet, T., Struys, M.M.. Pharmacokinetic models for propofol: defining and illuminating the devil in the detail. Br J Anaesth 2009; 103: 26–37.Google Scholar
Barakat, A.R., Sutcliffe, N, Schwab, M.. Effect site concentration during propofol TCI sedation: a comparison of sedation score with two pharmacokinetic models. Anaesthesia 2007; 62: 661–6.Google Scholar
Engbers, F.H., Sutcliffe, N., Kenny, G., Schraag, S.. Pharmacokinetic models for propofol: defining and illuminating the devil in the detail. Br J Anaesth 2010; 104: 261–2; author reply 62–4.Google Scholar
Engbers, F.. Is unconsciousness simply the reverse of consciousness? Anaesthesia 2018; 73: 6–9.Google Scholar
Engbers, F.H.M., Dahan, A.. Anomalies in target-controlled infusion: an analysis after 20 years of clinical use. Anaesthesia 2018; 73: 619–30.Google Scholar
Hughes, M.A., Glass, P.S., Jacobs, J.R.. Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anesthesiology 1992; 76: 334–41.Google Scholar
Kapila, A., Glass, P.S., Jacobs, J.R., et al. Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology 1995; 83: 968–75.CrossRefGoogle ScholarPubMed

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