TIVA TCI (total intravenous anaesthesia with target-controlled infusion)

TIVA TCI (total intravenous anaesthesia with target-controlled infusion) - total intravenous anaesthesia with target-controlled infusion.

General propofol anaesthesia using TCI models is safer for the patient and more comfortable for the anaesthetist. [1]

 The TCI technique uses a controlled software-controlled infusion pump that injects a drug (e.g. anaesthetic) into the patient based on patient parameters (age, gender, weight, height, etc.). The goal is to achieve a stable target concentration of the drug in the plasma.[2]

 Mathematical algorithms of TCI models for infusomats are calculated in such a way that the anaesthetist sets the desired concentration of propofol in the plasma, and the infuser itself changes the rate of administration of this drug according to the TCI algorithm. the rate of administration of this drug.

 No other methods of propofol administration (e.g., fixed rate of administration on an infuser), a stable concentration of of propofol in plasma is not achieved [4]. As a result:

●      patient may wake up during anaesthesia, especially when using muscle relaxants without brain monitoring (BIS). This leads to the need for constant bolus injections, which can cause a decrease in blood pressure [5]

●      At a At a fixed rate of administration, there is a risk of under- or overdose [6]

●      For severe patients or elderly patients, the use of lower target concentrations of the drug with titration of clinical effect is safer and may reduce the number of haemodynamic reactions [1]

Use of infusomats with TCI models for propofol, remifentanil, midazolam, etc. is a global modern practice. The most authoritative associations of anaesthetists (AAGBI, ESA) recommend this in their guidelines.

1. A. F. Nimmo et al Guidelines for the safe practice of total intravenous anaesthesia (TIVA) Anaesthesia 2018
2. J Crit Care Med (Targu Mures). 2022 Jan; 8(1): 3-5.22
.
3. Absalom AR, Mani V, De Smet T, Struys MM. Pharmacokinetic models for propofol-defining and illuminating the devil in the detail. British Journal of Anaesthesia 2009; 103: 26-37
.
4. 5th National Audit Project of The Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland
5. Absalom AR, Mani V, De Smet T, Struys MM. Pharmacokinetic models for propofol-defining and illuminating the devil in the detail. British Journal of Anaesthesia 2009; 103: 26-37
.