TARGET-CONTROLLED ANESTHESIA - CONCEPTS AND FIRST CLINICAL-EXPERIENCES

Propofol has a favourable pharmacokinetic profile for total intravenou s anaesthesia and several manual infusion schemes have been proposed t o maintain a constant blood concentration during anaesthesia. However, such schemes cannot respond predictably to changing surgical and anae sthetic requirements. A pharmacokinetic model for propofol has been in corporated into a target-controlled infusion system. This allows the d esired target blood concentration appropriate for any individual patie nt and level of surgical stimulation to be achieved and maintained at any time. There is no single blood concentration of an anaesthetic age nt which will result in satisfactory anaesthesia for all patients and all surgical conditions. It is necessary to titrate the target concent ration against each patient's clinical response. Target-controlled sys tems provide the best estimate of the blood concentration at any time and permit the required target concentration to be achieved as accurat ely and as rapidly as possible.