A target-controlled infusion is accomplished by a computer within the pump that performs rapid sequential calculations every 8 to 10 s to estimate the infusion rate required to produce a user-defined drug concentration in either the plasma or at the effect site of action of the drug in the brain in an open-loop system. The incorporation of parameter estimates into target-controlled infusion (or “smart”) pumps removed operator dependence.
#BOOKENDS TARGET BABY MANUAL#
Drug delivery rates (mass infusion rates) require frequent manual changes by the clinician to maintain the target concentration. These propofol pharmacokinetic parameter estimates for children were used to determine drug delivery rates given by pump that would achieve a plasma target concentration associated with anesthesia. The use of processed electroencephalographic monitoring is helpful in pediatric total intravenous anesthesia and target-controlled infusion anesthesia, particularly in the presence of neuromuscular blockade. Recommended target concentrations for both propofol and remifentanil depend on the type of surgery, the degree of surgical stimulation, the use of local anesthetic blocks, and the ventilatory status of the patient. Propofol validation studies suggest that these parameter estimates are satisfactory for the majority of children. There are two parameter sets, named after the first author describing them, that are commonly used in pediatric target-controlled infusion for propofol (Absalom and Kataria) and one for remifentanil (Minto). A linking rate constant parameter (keo) allows estimation of effect site concentration. Smart pumps programmed with pharmacokinetic parameter estimates administer drugs to a preset plasma concentration.
Drugs can be given as infusion controlled manually by the physician or as automated target-controlled infusion that targets plasma or effect site.
Propofol administered in conjunction with an opioid such as remifentanil is used to provide total intravenous anesthesia for children.
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