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„Target controlled infusion“ (TCI) – ein Konzept mit Zukunft?

Standortbestimmung, Handlungsempfehlungen und Blick in die Zukunft

Target-controlled infusion (TCI) – a concept with a future?

State-of-the-art, treatment recommendations and a look into the future

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Zusammenfassung

„Target controlled infusion“ (TCI) hat in den letzten 10 Jahren Entwicklung und Praxis der i.v.-Anästhesie nachhaltig beeinflusst, sodass wesentliche Fortschritte der Medikamentenapplikation in der perioperativen Medizin erreicht werden konnten. Neuere und aktuelle Entwicklungen wie „open TCI“ und die Verfügbarkeit von generischen Anästhetika zusammen mit modernen Infusionsspritzenpumpen ermöglichen, dass TCI ein fester Bestandteil im Methodenspektrum der Anästhesie werden kann und nicht mehr nur Spezialisten sowie Enthusiasten vorbehalten bleibt. Die vorliegende Übersicht beschreibt die Grundlagen der Zufuhr von i.v.-Anästhetika mit TCI und gibt Handlungsempfehlungen für eine erfolgreiche Implementierung in die klinische Praxis.

Abstract

Over the last 10 years the technique of target-controlled infusion (TCI) has substantially influenced the development and practice of intravenous anaesthesia. It opened the possibility of many new and exciting applications of perioperative anaesthetic care. More recent and current developments, such as open TCI (target-controlled infusion) and the availability of generic anaesthetic agents combined with modern infusion pumps, means that TCI can become a standard procedure in anaesthesia and is no longer just a research tool for specialists and enthusiasts. This review explains the fundamentals and applications of intravenous drug delivery by TCI and gives practice guidelines to successfully implement the technique into clinical practice. The aim is to provide a comprehensive reference based on clinically proven evidence.

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Literatur

  1. Absalom AR, Sutcliffe N, Kenny GN (2002) Closed-loop control of anesthesia using bispectral index: performance assessment in patients undergoing major orthopedic surgery under combined general and regional anesthesia. Anesthesiology 96: 67–73

    Article  PubMed  Google Scholar 

  2. Albertin A, Casati A, Federica L et al. (2005) The effect-site concentration of remifentanil blunting cardiovascular responses to tracheal intubation and skin incision during bispectral index-guided propofol anesthesia. Anesth Analg 101: 125–130; table

    Article  PubMed  CAS  Google Scholar 

  3. Albertin A, Colla G la, Colla L la et al. (2006) Effect site concentrations of remifentanil maintaining cardiovascular homeostasis in response to surgical stimuli during bispectral index guided propofol anesthesia in seriously obese patients. Minerva Anestesiol 72: 915–924

    PubMed  CAS  Google Scholar 

  4. Albertin A, Poli D, Colla L la et al. (2007) Predictive performance of „Servin’s formula” during BIS-guided propofol-remifentanil target-controlled infusion in morbidly obese patients. Br J Anaesth 98: 66–75

    Article  PubMed  CAS  Google Scholar 

  5. Albrecht S, Frenkel C, Ihmsen H, Schüttler J (1999) A rational approach to the control of sedation in intensive care unit patients based on closed-loop control. Eur J Anaesthesiol 16: 678–687

    Article  PubMed  CAS  Google Scholar 

  6. Barakat AR, Sutcliffe N, Schwab M (2007) Effect site concentration during propofol TCI sedation: a comparison of sedation score with two pharmacokinetic models. Anaesthesia 62: 661–666

    Article  PubMed  CAS  Google Scholar 

  7. Bauer M, Wilhelm W, Kraemer T et al. (2004) Impact of bispectral index monitoring on stress response and propofol consumption in patients undergoing coronary artery bypass surgery. Anesthesiology 101: 1096–1104

    Article  PubMed  CAS  Google Scholar 

  8. Bruhn J, Bouillon TW, Radulescu L et al. (2003) Correlation of approximate entropy, bispectral index, and spectral edge frequency 95 (SEF95) with clinical signs of „anesthetic depth“ during coadministration of propofol and remifentanil. Anesthesiology 98: 621–627

    Article  PubMed  CAS  Google Scholar 

  9. Campbell L, Imrie G, Doherty P et al. (2004) Patient maintained sedation for colonoscopy using a target controlled infusion of propofol. Anaesthesia 59: 127–132

    Article  PubMed  CAS  Google Scholar 

  10. Castro V de, Godet G, Mencia G et al. (2003) Target-controlled infusion for remifentanil in vascular patients improves hemodynamics and decreases remifentanil requirement. Anesth Analg 96: 33–38; table

    Article  PubMed  Google Scholar 

  11. Chaudhri S, White M, Kenny GN (1992) Induction of anaesthesia with propofol using a target-controlled infusion system. Anaesthesia 47: 551–553

    Article  PubMed  CAS  Google Scholar 

  12. Fechner J, Albrecht S, Ihmsen H et al. (1998) Prädiktivität und Präzision einer „target-controlled infusion“ (TCI) von Propofol mit dem System „Disoprifusor TCI“. Anaesthesist 47: 663–668

    Article  PubMed  CAS  Google Scholar 

  13. Irwin MG, Thompson N, Kenny GN (1997) Patient-maintained propofol sedation. Assessment of a target-controlled infusion system. Anaesthesia 52: 525–530

    Article  PubMed  CAS  Google Scholar 

  14. Kazama T, Ikeda K, Morita K et al. (1999) Comparison of the effect-site k(eO)s of propofol for blood pressure and EEG bispectral index in elderly and younger patients. Anesthesiology 90: 1517–1527

    Article  PubMed  CAS  Google Scholar 

  15. Kenny GN, White M (1992) A portable target controlled propofol infusion system. Int J Clin Monit Comput 9: 179–182

    Article  PubMed  CAS  Google Scholar 

  16. Kreuer S, Biedler A, Larsen R et al. (2001) The Narcotrend – a new EEG monitor designed to measure the depth of anaesthesia. A comparison with bispectral index monitoring during propofol-remifentanil anaesthesia. Anaesthesist 50: 921–925

    Article  PubMed  CAS  Google Scholar 

  17. Kreuer S, Biedler A, Larsen R et al. (2003) Narcotrend monitoring allows faster emergence and a reduction of drug consumption in propofol-remifentanil anesthesia. Anesthesiology 99: 34–41

    Article  PubMed  CAS  Google Scholar 

  18. Kreuer S, Bruhn J, Larsen R et al. (2003) Comparison of Alaris AEP index and bispectral index during propofol-remifentanil anaesthesia. Br J Anaesth 91: 336–340

    Article  PubMed  CAS  Google Scholar 

  19. Leitch JA, Sutcliffe N, Kenny GN (2003) Patient-maintained sedation for oral surgery using a target-controlled infusion of propofol – a pilot study. Br Dent J 194: 43–45

    Article  PubMed  CAS  Google Scholar 

  20. Lichtenbelt BJ, Mertens MJ, Vuyk J (2004) Strategies to optimise propofol-opioid anaesthesia. Clin Pharmacokinet 43: 577–593

    Article  PubMed  CAS  Google Scholar 

  21. Mertens MJ, Olofsen E, Engbers FH et al. (2003) Propofol reduces perioperative remifentanil requirements in a synergistic manner: response surface modeling of perioperative remifentanil-propofol interactions. Anesthesiology 99: 347–359

    Article  PubMed  CAS  Google Scholar 

  22. Milne SE, Kenny GN, Schraag S (2003) Propofol sparing effect of remifentanil using closed-loop anaesthesia. Br J Anaesth 90: 623–629

    Article  PubMed  CAS  Google Scholar 

  23. Nieuwenhuijs DJ, Olofsen E, Romberg RR et al. (2003) Response surface modeling of remifentanil-propofol interaction on cardiorespiratory control and bispectral index. Anesthesiology 98: 312–322

    Article  PubMed  CAS  Google Scholar 

  24. Russell D (1998) Intravenous anaesthesia: manual infusion schemes versus TCI systems. Anaesthesia 53 [Suppl 1]: 42–45

  25. Schraag S, Kenny GN, Mohl U, Georgieff M (1998) Patient-maintained remifentanil target-controlled infusion for the transition to early postoperative analgesia. Br J Anaesth 81: 365–368

    PubMed  CAS  Google Scholar 

  26. Schraag S, Flaschar J, Georgieff M (2000) Target controlled infusion (TCI) – status and clinical perspectives. Anasthesiol Intensivmed Notfallmed Schmerzther 35: 12–20

    Article  PubMed  CAS  Google Scholar 

  27. Schraag S, Flaschar J, Schleyer M et al. (2006) The contribution of remifentanil to middle latency auditory evoked potentials during induction of propofol anesthesia. Anesth Analg 103: 902–907

    Article  PubMed  CAS  Google Scholar 

  28. Schwilden H, Fechner J, Albrecht S et al. (2003) Testing and modelling the interaction of alfentanil and propofol on the EEG. Eur J Anaesthesiol 20: 363–372

    Article  PubMed  CAS  Google Scholar 

  29. Servin FS (1998) TCI compared with manually controlled infusion of propofol: a multicentre study. Anaesthesia 53 [Suppl 1]: 82–86

    Google Scholar 

  30. Smith C, McEwan E, Jhaveri R et al. (1994) The interaction of fentanyl on the Cp50 of propofol for loss of consciousness and skin incision. Anesthesiology 81: 820–828

    Article  PubMed  CAS  Google Scholar 

  31. Smith I, White PF, Nathanson M, Gouldson R (1994) Propofol: an update on its clinical uses. Anesthesiology 81: 1005–1043

    Article  PubMed  CAS  Google Scholar 

  32. Struys MM, Smet T de, Depoorter B et al. (2000) Comparison of plasma compartment versus two methods for effect compartment–controlled target-controlled infusion for propofol. Anesthesiology 92: 399–406

    Article  PubMed  CAS  Google Scholar 

  33. Struys MM, Smet T de, Versichelen LF et al. (2001) Comparison of closed-loop controlled administration of propofol using Bispectral Index as the controlled variable versus „standard practice“ controlled administration. Anesthesiology 95: 6–17

    Article  PubMed  CAS  Google Scholar 

  34. Struys MM, Smet T de, Greenwald S et al. (2004) Performance evaluation of two published closed-loop control systems using bispectral index monitoring: a simulation study. Anesthesiology 100: 640–647

    Article  PubMed  Google Scholar 

  35. Vuyk J, Engbers FH, Lemmens HJ et al. (1992) Pharmacodynamics of propofol in female patients. Anesthesiology 77: 3–9

    Article  PubMed  CAS  Google Scholar 

  36. Vuyk J, Lim TA, Engbers FH et al. (1995) The pharmacodynamic interaction of propofol and alfentanil during lower abdominal surgery in women. Anesthesiology 83: 8–22

    Article  PubMed  CAS  Google Scholar 

  37. Vuyk J, Mertens MJ, Olofsen E et al. (1997) Propofol anesthesia and rational opioid selection: determination of optimal EC50-EC95 propofol-opioid concentrations that assure adequate anesthesia and rapid return of consciousness. Anesthesiology 87: 1549–1562

    Article  PubMed  CAS  Google Scholar 

  38. Vuyk J, Oostwouder CJ, Vletter AA et al. (2001) Gender differences in the pharmacokinetics of propofol in elderly patients during and after continuous infusion. Br J Anaesth 86: 183–188

    Article  PubMed  CAS  Google Scholar 

  39. White M, Kenney GN (1990) Intravenous propofol anaesthesia using a computerised infusion system. Anaesthesia 45: 204–209

    Article  PubMed  CAS  Google Scholar 

  40. Wietasch JK, Scholz M, Zinserling J et al. (2006) The performance of a target-controlled infusion of propofol in combination with remifentanil: a clinical investigation with two propofol formulations. Anesth Analg 102: 430–437

    Article  PubMed  CAS  Google Scholar 

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Interessenkonflikt

Alle Autoren sind Mitglied eines von FreseniusKabi, Bad Homburg, unterstützen „Target Controlled Infusion Expert Board“. Dieses Projekt wurde durch ein Grant von FreseniusKabi unterstützt.

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Authors and Affiliations

  1. Department of Perioperative Medicine, Golden Jubilee National Hospital, Beardmore Street, Clydebank, Glasgow, Scotland, UK

    S. Schraag MD

  2. Klinik für Anästhesiologie, Intensivmedizin und SchmerztherapieHomburg/Saar, Homburg/Saar, Deutschland

    S. Kreuer

  3. Department of Anaesthesiology, Radboud University Nijmegen Medical CentreNijmegen, Nijmegen, Niederlande

    J. Bruhn

  4. Klinik für Anästhesiologie, Städtisches Klinikum Lüneburg, Lüneburg, Deutschland

    C. Frenkel

  5. Anästhesiologische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland

    S. Albrecht

Authors
  1. S. Schraag MD
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  2. S. Kreuer
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  3. J. Bruhn
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  4. C. Frenkel
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  5. S. Albrecht
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Correspondence to S. Schraag MD.

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Schraag, S., Kreuer, S., Bruhn, J. et al. „Target controlled infusion“ (TCI) – ein Konzept mit Zukunft?. Anaesthesist 57, 223–230 (2008). https://doi.org/10.1007/s00101-008-1329-7

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  • DOI: https://doi.org/10.1007/s00101-008-1329-7

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