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Pump Pitfalls and Practicalities

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Total Intravenous Anesthesia and Target Controlled Infusions

Abstract

Planning to give the right drug with the right dose to the right patient is mandatory for a successful application of intravenous anaesthesia. Making sure that this dose will be delivered to the patient at all times in the course of an anaesthetic procedure is of equal importance. This requires knowledge of the infusion device and how to control it. It requires thoughtful setup of infusion systems including the lines to avoid disturbances in the flow of the drug to the patient. As no system can be guaranteed to be fail-safe, back up plans need to be available to cope with situations not expected when starting the anaesthesia. In addition, inexperienced clinicians who use intravenous techniques need to be properly trained and educated. In this chapter, syringe driving infusion pumps will be discussed in general but particularly in relation to target (TCI) and effect target-controlled infusion (ETCI). Issues to be discussed include the effect of occlusions and alarm settings and how to connect the syringe to the patient. Possible pitfalls caused by, for example, dead space in the infusion line and how to deal with situations like a failing TCI system or an inadvertently reset or not reset TCI device will be addressed.

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References

  1. Peterfreund RA, Philip JH (2013) Critical parameters in drug delivery by intravenous infusion. Exp Opin Drug Deliv. 10(8):1095–108. doi:10.1517/17425247.2013.785519.

  2. Struys MMRF, De-Smet T, Glen JIB, Vereecke HEM, Absalom AR, Schnider TW. The history of target-controlled infusion. Anesth Analg. 2016;122(1):56–69. doi:10.1213/ANE.0000000000001008.

    Article  CAS  PubMed  Google Scholar 

  3. Schraag S, Flaschar J. Delivery performance of commercial target-controlled infusion devices with diprifusor module. Eur J Anaesthesiol. 2002;19(5):357–60. doi:10.1017/S0265021502000571.

    Article  CAS  PubMed  Google Scholar 

  4. Sarraf E, Mandel JE. Time-delay when updating infusion rates in the Graseby 3400 pump results in reduced drug delivery. Anesth Analg. 2014;118(1):145–50. doi:10.1213/01.ane.0000438349.21617.2f.

    Article  CAS  PubMed  Google Scholar 

  5. Engbers FHM. Total intravenous anaesthesia: the equipment. In: Vuyk J, Mulder S, Engbers F, editors. On the study and practice of intravenous anaesthesia. Dordrecht: Kluwer Academic Publishers; 2000. p. 71–81.

    Google Scholar 

  6. Chiou WL. Potential pitfalls in the conventional pharmacokinetic studies: effects of the initial mixing of drug in blood and the pulmonary first-pass elimination. J Pharmacokinet Biopharm. 1979;7:527–36.

    Article  CAS  PubMed  Google Scholar 

  7. Glen JIB, Engbers FHM. The influence of target concentration, equilibration rate constant (ke0) and pharmacokinetic model on the initial propofol dose delivered in effect-site target-controlled infusion. Anaesthesia. 2016;71(3):306–14. doi:10.1111/anae.13345.

  8. Chan E, Hubbard A, Sane S, Maa Y-F. Syringe siliconization process investigation and optimization. J Pharm Sci Technol. 2012;66(2):136–50. doi:10.5731/pdajpst.2012.00856.

    CAS  Google Scholar 

  9. Schulz G, Fischer J, Neff T, Bänziger O, Weiss M. The effect of air within the infusion syringe on drug delivery of syringe pump infusion systems. Anaesthesist. 2000;49(12):1018–23.

    Article  CAS  PubMed  Google Scholar 

  10. Kern H, Kuring A, Redlich U, Döpfmer UR, Sims NM, Spies CD, Kox WJ. Downward movement of syringe pumps reduces syringe output. Br J Anaesth. 2001;86(6):828–31.

    Article  CAS  PubMed  Google Scholar 

  11. McCarroll C, McAtamney D, Taylor R. Alteration in flow delivery with antisyphon devices. Anaesthesia. 2000;55(4):355–7.

    Article  CAS  PubMed  Google Scholar 

  12. Sundaram R, Dell AE. Interaction between infusion equipment resulting in drug overdose in a critically ill patient. Anaesthesia. 2005;60(1):88–91. doi:10.1111/j.1365-2044.2004.04012.x.

    Article  CAS  PubMed  Google Scholar 

  13. Lannoy D, Décaudin B, Dewulf S, Simon N, Secq A, Barthélémy C, et al. Infusion set characteristics such as antireflux valve and dead-space volume affect drug delivery: an experimental study designed to enhance infusion sets. Anesth Analg. 2010;111(6):1427–31. doi:10.1213/ANE.0b013e3181f66ee3.

    Article  CAS  PubMed  Google Scholar 

  14. Lovich MA, Doles J, Peterfreund RA. The impact of carrier flow rate and infusion set dead-volume on the dynamics of intravenous drug delivery. Anesth Analg. 2005;100(4):1048–55. doi:10.1213/01.ANE.0000146942.51020.88.

    Article  CAS  PubMed  Google Scholar 

  15. Lovich MA, Kinnealley ME, Sims NM, Peterfreund RA. The delivery of drugs to patients by continuous intravenous infusion: modeling predicts potential dose fluctuations depending on flow rates and infusion system dead volume. Anesth Analg. 2006;102(4):1147–53. doi:10.1213/01.ane.0000198670.02481.6b.

    Article  CAS  PubMed  Google Scholar 

  16. Rieschke P, LaFleur BJ, Janicki PK. Effects of EDTA- and sulfite-containing formulations of propofol on respiratory system resistance after tracheal intubation in smokers. Anesthesiology. 2003;98(2):323–8.

    Article  CAS  PubMed  Google Scholar 

  17. Muller AE, Huisman I, Roos PJ, Rietveld AP, Klein J, Harbers JBM, Dorresteijn JJ, van Steenbergen JE, Vos MC. Outbreak of severe sepsis due to contaminated propofol: lessons to learn. J Hosp Infect. 2010;76(3):225–30.

    Article  CAS  PubMed  Google Scholar 

  18. Cole DC, Baslanti TO, Gravenstein NL, Gravenstein N. Leaving more than your fingerprint on the intravenous line: a prospective study on propofol anesthesia and implications of stopcock contamination. Anesth Analg. 2015;120(4):861–7. doi:10.1213/ANE.0b013e318292ed45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Nakao M, Yamanaka S, Iwata M, Nakashima M, Onji I. [The cracks of polycarbonate three-way stopcocks are enhanced by the lubricating action of fat emulsion of propofol]. Masui. 2003;52(11):1243–7.

    PubMed  Google Scholar 

  20. Schnider TW, Minto CF, Shafer SL, Gambus PL, Andresen C, Goodale DB, Youngs EJ. The influence of age on propofol pharmacodynamics. Anesthesiology. 1999;90(6):1502–16.

    Article  CAS  PubMed  Google Scholar 

  21. Absalom AR, Mani V, De Smet T, Struys MMRF. Pharmacokinetic models for propofol--defining and illuminating the devil in the detail. Br J Anaesth. 2009;103(1):26–37. doi:10.1093/bja/aep143.

    Article  CAS  PubMed  Google Scholar 

  22. Engbers FH, Sutcliffe N, Kenny G, Schraag S. Pharmacokinetic models for propofol: defining and illuminating the devil in the detail. Br J Anaesth. 2010;104(2):261–2, author reply 262–4. doi:10.1093/bja/aep385.

  23. Dawson PJ, Bjorksten AR, Blake DW, Goldblatt JC. The effects of cardiopulmonary bypass on total and unbound plasma concentrations of propofol and midazolam. Yjcan. 1997;11(5):556–61. doi:10.1016/S1053-0770(97)90003-3.

    CAS  Google Scholar 

  24. Peeters MYM, Bras LJ, DeJongh J, Wesselink RMJ, Aarts LPHJ, Danhof M, Knibbe CAJ. Disease severity is a major determinant for the pharmacodynamics of propofol in critically ill patients. Clin Pharmacol Ther. 2008;83(3):443–51. doi:10.1038/sj.clpt.6100309.

    Article  CAS  PubMed  Google Scholar 

  25. Anderson BJ, Meakin GH. Scaling for size: some implications for paediatric anaesthesia dosing. Paediatr Anaesth. 2002;12(3):205–19.

    Article  PubMed  Google Scholar 

  26. Donmez A, Araz C, Kayhan Z. Syringe pumps take too long to give occlusion alarm. Pediatr Anesth. 2005;15(4):293–6. doi:10.1111/pan.2005.15.issue-4.

    Article  CAS  Google Scholar 

  27. Absalom A. Accuracy of the “Paedfusor” in children undergoing cardiac surgery or catheterization. Br J Anaesth. 2003;91(4):507–13. doi:10.1093/bja/aeg220.

    Article  CAS  PubMed  Google Scholar 

  28. Kataria BK, Ved SA, Nicodemus HF, Hoy GR, Lea D, Dubois MY, et al. The pharmacokinetics of propofol in children using three different data analysis approaches. Anesthesiology. 1994;80(1):104–22.

    Article  CAS  PubMed  Google Scholar 

  29. Knibbe CAJ, Zuideveld KP, Aarts LPHJ, Kuks PFM, Danhof M. Allometric relationships between the pharmacokinetics of propofol in rats, children and adults. Br J Clin Pharmacol. 2005;59(6):705–11. doi:10.1111/j.1365-2125.2005.02239.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Greeley WJ, de Bruijn NP, Davis DP. Sufentanil pharmacokinetics in pediatric cardiovascular patients. Anesth Analg. 1987;66(11):1067–72.

    Article  CAS  PubMed  Google Scholar 

  31. Iwakiri H, Nishihara N, Nagata O, Matsukawa T, Ozaki M, Sessler DI. Individual effect-site concentrations of propofol are similar at loss of consciousness and at awakening. Anesth Analg. 2005;100(1):107–10. doi:10.1213/01.ANE.0000139358.15909.EA.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. McGlone and Peck. Bulletin RCoA 91, 2015. p. 47–9. https://www.rcoa.ac.uk/system/files/CSQ-Bulletin91_1.pdf. Accessed 11 Mar 2016.

  33. Barvais L, Lobo FA, Engbers FHM, Irwin MG, Schnider TW, Schraag S. Tips and tricks to optimize total intravenous anesthesia. Acta Anaesthesiol Belg. 2013;64(4):137–46.

    CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Leiden University Medical Centre, Albinusdreef 2 Leiden, Leiden, ZH 2333 ZA, The Netherlands

    Frank Engbers MD, FRCA

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  1. Frank Engbers MD, FRCA
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Correspondence to Frank Engbers MD, FRCA .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Anthony R. Absalom

  2. Department of Anesthesia, Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA

    Keira P. Mason

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Engbers, F. (2017). Pump Pitfalls and Practicalities. In: Absalom, A., Mason, K. (eds) Total Intravenous Anesthesia and Target Controlled Infusions. Springer, Cham. https://doi.org/10.1007/978-3-319-47609-4_18

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  • DOI: https://doi.org/10.1007/978-3-319-47609-4_18

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-47607-0

  • Online ISBN: 978-3-319-47609-4

  • eBook Packages: MedicineMedicine (R0)

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