Predictive accuracy of target-controlled propofol and sufentanil coinfusion in long-lasting surgery

Background The predictive accuracy of target concentration infusions of pro pofol has been documented only for less than 4 h, and no prospective study of sufentanil target controlled infusion is available. The authors investig ated the predictive accuracy of pharmacokinetic models for propofol and suf entanil coadministered during long-lasting surgery. Methods: Ten patients, American Society of Anesthesiologists physical statu s I and II, were studied during extended cervicofacial surgery. Target cont rolled infusion of propofol and sufentanil was administered during surgery using decisional algorithms, taking into consideration pain assessment, hem odynamic changes, and peroperative blood losses. Intrasubject data analysis included calculation of performance error, median performance error, media n absolute performance error, divergence, and wobble. Results: The range of plasma target concentrations was 2-5 mu g/ml for prop ofol and 0.2-1 ng/ml for sufentanil. Median performance error was -12.1% fo r propofol and -10% for sufentanil The wobble values were 11.6% and 22.3% f or propofol and sufentanil, respectively. The pharmacokinetic sets used sli ghtly overpredicted the concentrations, with negative values of divergence of 2.92% and 0.22% units/h for propofol and sufentanil, for a mean infusion period of 762 min. Conclusions: This prospective study demonstrates the predictive accuracy of the pharmacokinetic model for sufentanil infusion and confirms that for pr opofol during long-lasting surgery using standardized rules for the managem ent of target controlled infusion and blood loss replacement.