Correction of target-controlled infusion following wrong selection of emulsion concentrations of propofol
Korean Journal of Anesthesiology 2014³â 66±Ç 5È£ p.377 ~ p.382
äÀ±Á¤(Chae Yun-Jeong) - Ajou University School of Medicine Department of Anesthesiology and Pain Medicine
Á¶Çѹü(Joe Han-Bum) - Ajou University School of Medicine Department of Anesthesiology and Pain Medicine
ÀÌ¿øÀÏ(Lee Won-Il) - Ajou University School of Medicine Department of Anesthesiology and Pain Medicine
±èÁø¾Æ(Kim Jin-A) - Ajou University School of Medicine Department of Anesthesiology and Pain Medicine
¹Î»ó±â(Min Sang-Kee) - Ajou University School of Medicine Department of Anesthesiology and Pain Medicine
Abstract
Background: We investigated the correction methods following wrong-settings of emulsion concentrations of propofol as a countermeasure against erroneous target-controlled infusions (TCI).
Methods: TCIs were started with targeting 4.0 ¥ìg/ml of effect-site concentration (Ceff) of propofol, and the emulsion concentrations were selected for 2.0% instead of 1.0% (FALSE1-2, n = 24), or 1.0% instead of 2.0% (FALSE2-1, n = 24). These wrong TCIs were corrected at 3 min after infusion start. During FALSE1-2, the deficit was filled up while injecting after equilibrium (n = 12), or while overriding (n = 12). During FALSE2-1, the overdose was evacuated while targeting Ceff (n = 12) or targeting plasma concentration (Cp) (n = 12). The gravimetrical measurements of TCI reproduced the Cp and Ceff using simulations. The reproduced Ceff at 3 min (Ceff-3min) and the time to be normalized within ¡¾ 5% of target Ceff (T¡¾5%), were compared between the correction methods.
Results: During the wrong TCI, Ceff-3min was 1.98 ¡¾ 0.01 ¥ìg/ml in FALSE1-2, and 7.99 ¡¾ 0.05 ¥ìg/ml in FALSE2-1. In FALSE1-2, T¡¾5% was significantly shorter when corrected while overriding (3.9 ¡¾ 0.25 min), than corrected after equilibrium (6.9 ¡¾ 0.05 min) (P < 0.001). In FALSE2-1, T¡¾5% was significantly shorter during targeting Cp (3.6 ¡¾ 0.04 min) than targeting Ceff (6.7 ¡¾ 0.15 min) (P < 0.001).
Conclusions: The correction methods, based on the pharmacokinetic and pharmacodynamic characteristics, could effectively and rapidly normalize the wrong TCI following erroneously selections of the emulsion concentration of propofol.
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Drug delivery systems, Infusion pumps, Intravenous infusion, Propofol
KMID :
0356920140660050377
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