Abstract
Fortunately, the simplicity of the clinical application of target controlled infusion (TCI) is far removed from the complexity of the mathematical basis of the concept, as originally proposed by Kruger -Theimer1 and Schwilden.2 A small group of pioneers with an understanding of mathematics, pharmacokinetics, computers and anaesthesiology has translated the complex equations described into the reality of a simple method to achieve and maintain a pseudo steady-state blood or brain concentration of various iv therapies. The ’Diprifusor’TCI system (AstraZeneca) for the administration of propofol was the first commercial system to be approved by regulatory authorities. Users of this system do not require a detailed knowledge of the basic sciences on which this device has been built. As a clinical tool, a TCI system simplifies the administration of iv agents, and provides the anaesthetist with greater precision in the control of depth of anaesthesia or sedation, as the target drug concentration can be titrated upwards and downwards in a predictable and reproducible manner. In this way, control is similar to that achieved by adjustment of the inspired concentration of an inhalational agent and a TCI system can be seen as the iv. equivalent of a vaporizer. This article summarizes briefly the evolution of TCI systems and looks at recent enhancements and possible future developments
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References
E. Kruger-Thiemer, Continuous intravenous infusion and multicompartment accumulation, Eur. J. Pharmacol. 4, 317–24 (1968).
H. Schwilden, A general method for calculating the dosage scheme in linear pharmacokinetics, Eur. J. Clin. Pharmacol. 20, 379–86 (1981). (1937).
J. Schuttler, H. Schwilden and H Stoeckel, Pharmacokinetics as applied to intravenous anaesthesia: practical applications, Anaesthesia 38 (Supp), 53–56 (1983).
J.M. Alvis, J. G. Reves, A. V. Govier, P. G. Menkhaus, C. E. Henling, J. A. Spain and E. Bradley, Computer assisted continuous infusion of fentanyl during cardiac anesthesia: comparison with manual method, Anesthesiology 63, 41–49 (1985).
J Jacobs, Algorithm for optimal linear model-based control with application to pharmacokinetic model-driven drug delivery, IEEE Trans. Biomed. Eng.37,107–109 (1990).
J. M Bailey and S. L. Shafer, A simple analytical solution to the three-compartment pharmacokinetic model suitable for computer-controlled infusion pumps, IEEE Trans. Biomed. Eng. 38, 522–25 (1997).
J. Schuttler, S. Kloos, H. Schwilden and H. Stoeckel, Total intravenous anaesthesia with propofol and alfentanil by computer assisted infusion, Anaesthesia 43, Supp, 2–7 (1988).
M. White and G.N.C. Kenny, Intravenous propofol anaesthesia using a computerised infusion system, Anaesthesia 45, 204–09 (1990).
M. E. Ausems, D. R. Stanski and C. C. Hug, An evaluation of the accuracy of pharmacokinetic data for the computer assisted infusion of alfentanil, Br J. Anaesth. 57, 1217–25 (1985).
S. L. Shafer, J. R. Varvel, N. Aziz and J. C. Scott, Pharmacokinetics of fentanyl administered by computer controlled infusion pump, Anesthesiology 73, 1091–1102 (1998).
P.S.A. Glass, J.B. Glen, G.N.C. Kenny, J. Schuttler and S.L. Shafer, Nomenclature for computer-assisted infusion devices, Anesthesiology 86, 1430–31 (1997).
J.R. Varvel, D.L. Donoho and S.L. Shafer, Measuring the predictive performance of computer-controlled infusion pumps, J. Pharmacokin. Biopharm. 20, 63–93 (1992).
E. Gepts, Pharmacokinetic concepts for TCI anaesthesia, Anaesthesia 53, Supp. 1:4–12 (1998).
J. M. Gray and G. N. C. Kenny, Development of the technology for ’Diprifusor’ TCI systems, Anaesthesia 53, Supp.l: 22–27 (1998).
J.B. Glen, The development of ’Diprifusor’: a TCI system for propofol, Anaesthesia 53, Supp.1:13–21 (1998).
B. Marsh, M. White, N. Morton and G.N.C. Kenny, Pharmacokinetic model driven infusion of propofol in children, Br. J. Anaesth. 67,41–48 (1991).
J.F. Coetzee, J.B. Glen, CA. Wium and L. Boshoff, Pharmacokinetic model selection for target controlled infusions of propofol, Anesthesiology 82,1328–1345 (1995).
J.A.C. Murdoch, S.A. Grant and G.N.C. Kenny, Safety of patient-maintained propofol sedation using a target-controlled system in healthy volunteers, Br J. Anaesth. 85, 299–301 (2000).
E. Doyle, W. McFadzean and N. S. Morton, I.V. anaesthesia with propofol using a target controlled infusion system: comparison with inhalation anaesthesia for general surgical procedures in children, Br. J. Anaesth. 70, 542–545 (1993).
M. White, F. H. M. Engbers, M. J. Schenkels, A. G. L. Burm and J. G. Bovill, The pharmacodynamics of propofol determined by auditory evoked potentials, Proc. 11 th WCA, 14–20th April, Sydney: P610 (1996).
T. W. Schnider, C. F. Minto, P. L. Gambus, C. Andresen, D. B. Goodale, S. L. Shafer and E. Youngs, The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers, Anesthesiology 88, 1170–82 (1998).
J. Schuttler and H. Ihmsen, Population pharmacokinetics of propofol, Anesthesiology 92, 727–738 (2000).
J. Vuyk, CJ. Oostwouder, A.A. Vletter, A G. L. Burm and J. G. Bovill, Br J. Anaesth. 86,183–88 (2001).
C. F. Minto, T. W. Schnider, T. D. Egan, E. Youngs, HJ. M. Lemmens, P. L. Gambus, V. Billard, J. F. Hoke, K. H. P. Moore, D. J. Hermann, K. T. Muir, J. W. Mandema and S. L. Shafer, Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil, Anesthesiology 86,10–23 (1997).
S.L. Shafer and K.M. Gregg, Algorithms to rapidly achieve and maintain stable drug concentrations at the site of drug effect, J. Pharmacokin. Biopharm. 20,147–69 (1992).
J.R. Jacobs and E.A. Williams, Algorithm to control “Effect Compartment” drug concentrations in pharmacokinetic model-driven drug delivery, IEEE Trans. Biomed. Eng. 40, 993–99 (1993).
T.W. Schnider, C. F. Minto, S. L. Shafer, P. L. Gambus, C. Andresen, D. B. Goodale and E. J. Youngs, The influence of age on propofol pharmacodynamics, Anesthesiology 90, 1502–16 (1999).
V. Billard, PL Gambus, N. Chamoun, D. R. Stanski, S. L. Shafer, A comparison of spectral edge, delta power, and bispectral index as EEG measures of alfentanil, propofol and midazolam drug effects, Clin. Pharmacol. Ther. 61, 45–58 (1997).
M.M.R.F. Struys, T. De Smet, B. Depoorter, L.F.M. Versichelen, E.P. Mortier, F.J.E. Dumortier, S.L. Shafer and G. Roily, Comparison of plasma compartment versus two methods for effect compartment-controlled target controlled infusion of propofol, Anesthesiology 92, 399–406 (2000).
T. Kazama, K. Ikeda, K. Morita, M. Kikura, M. Doi, T. Ikeda, T. Kurita and Y. Nakajima, Comparison of the effect-site keOs of propofol for blood pressure and EEG bispectral index in elderly and younger patients, Anesthesiology 90,1517–27 (1999).
D Russell, Intravenous anaesthesia: manual infusion schemes versus TCI systems, Anaesthesia 53, Supp 1: 42–45 (1998).
J. Vuyk, T. Lim, F. H. M. Engbers, A. G. L. Burm, A. A. Vletter and Bovill JG. Thepharmacodynamic interaction of propofol and alfentanil during lower abdominal surgery in women, Anesthesiology 83, 8–22 (1995).
L. L. Gustafsson, W. F. Ebling, E. Osaki, S Harapat, D. R. Stanski and S. L. Shafer, Plasma concentration clamping in the rat using a computer-controlled infusion pump, Pharmaceutical Res. 9, 800–07 (1992).
T. Beths, J. B. Glen, J. Reid, A. M. Monteiro and A. M. Nolan, Evaluation and optimisation of a target-controlled infusion system for administering propofol to dogs as part of a total intravenous anaesthetic technique during dental surgery, Veterinary Record 148, 198–203 (2001).
S. Albrecht, C. Frenkel, H. Ihmsen and J. Schuttler, A rational approach to the control of sedation in intensive care unit patients based on closed-loop control, Europ. J. Anaesthesiol. 16, 678–87 (1999).
A. R. Absalom, N. Sutcliffe and G. N. Kenny, Closed-loop control of anaesthesia using bispectral index, Anesthesiology 96, 67–73 (2002).
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Glen, J.B. (2003). The Development and Future of Target Controlled Infusion. In: Vuyk, J., Schraag, S. (eds) Advances in Modelling and Clinical Application of Intravenous Anaesthesia. Advances in Experimental Medicine and Biology, vol 523. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-9192-8_12
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DOI: https://doi.org/10.1007/978-1-4419-9192-8_12
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