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    ITIVA Lecture

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    pavel.ermolaev
    The document provides guidelines for using target controlled infusion (TCI) of propofol and remifentanil for anesthesia, including recommended effect site concentrations for induction, maintenance of different surgical procedures, and emergence from anesthesia. It also discusses using BIS monitoring to guide propofol dosing and adjusting remifentanil to control hemodynamics and provide adequate analgesia. Clinical cases are presented as examples of applying these TCI guidelines for a brain MRI and laparoscopic cholecystectomy.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    ITIVA Lecture

    Uploaded by

    pavel.ermolaev
    36 views16 pages
    The document provides guidelines for using target controlled infusion (TCI) of propofol and remifentanil for anesthesia, including recommended effect site concentrations for induction, maintenance of different surgical procedures, and emergence from anesthesia. It also discusses using BIS monitoring to guide propofol dosing and adjusting remifentanil to control hemodynamics and provide adequate analgesia. Clinical cases are presented as examples of applying these TCI guidelines for a brain MRI and laparoscopic cholecystectomy.

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    The document provides guidelines for using target controlled infusion (TCI) of propofol and remifentanil for anesthesia, including recommended effect site concentrations for induction, maintenance of different surgical procedures, and emergence from anesthesia. It also discusses using BIS monitoring to guide propofol dosing and adjusting remifentanil to control hemodynamics and provide adequate analgesia. Clinical cases are presented as examples of applying these TCI guidelines for a brain MRI and laparoscopic cholecystectomy.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    36 views16 pages

    ITIVA Lecture

    Uploaded by

    pavel.ermolaev
    The document provides guidelines for using target controlled infusion (TCI) of propofol and remifentanil for anesthesia, including recommended effect site concentrations for induction, maintenance of different surgical procedures, and emergence from anesthesia. It also discusses using BIS monitoring to guide propofol dosing and adjusting remifentanil to control hemodynamics and provide adequate analgesia. Clinical cases are presented as examples of applying these TCI guidelines for a brain MRI and laparoscopic cholecystectomy.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 16

    Assistant for manual TCI

    David Eduardo Ramírez


    Anesthesiologist
    Stress

    Theoretical concentrations
    for an adequate anesthesia

    incision
    Intubation

    Apprehension
    Surgical silence end of Sx
    Time
    TRICOMPARTIMENTAL MODELS
    TRICOMPARTIMENTAL MODELS

    DOSIS
    Efecto
    keo

    k12 k13
    V2 V1 V3
    k21 k31

    k10
    Effect site: Hysteresis

    Scott JC et al. Anesthesiology 1985;62:234-241


    TCI
    (Target controlled
    infusion)
    • Better hemodynamic stability
    Less hypotension
    Less bradycardia
    • Fewer apnea episodes during sedation
    • Reduced remifentanil consumption
    Lower plasma concentration
    High plasma concentrations are associated with
    hyperalgesia
    Example: Respiratory depression

    Diederik J.F. Nieuwenhuijs. Response Surface Modeling of Remifentanil–Propofol Interaction on Cardiorespiratory Control and
    Bispectral Index. Anesthesiology 2 2003, Vol.98, 312-322
    Remifentanil 0.15 mcg/kg/min

    Minuto Concentración (ng/ml)


    - 1 0.4
    - 2 1
    - 5 2.2
    - 10 3
    - 30 3.8
    Perfusors
    Induction

    Propofol ES Remifentanil ES NMB


    Schnider: 4-6 mcg/ml LMA - OT 4 – 7 ng/ml 2 ED95
    Eleveld: 2 – 3 mcg/ml Sedation: 0 – 1 ng/ml
    Sedation 0 / 1 - 1.5
    Maintenance ng/ml
    Sx silence 2-3 ng/ml
    Propofol ES Remifentanil ES
    • Hypnosis -> 2.5 - 3 mcg/ml Soft tissue 3-4 ng/ml
    2 – 6 ng/ml
    • Sedation -> 1.5 – 2.5 mcg/ml Analgesia Abdomen 4-5 ng/ml
    Laparoscopy 5-6 ng/ml
    Thorax 6-7 ng/ml
    BIS 40-60 TAS mmHg HR x Min
    c

    c
    < 40 > 60 > 20% Basal < 20% Basal > 20% Basal < 40 bpm
    Settings

    ↓ES 0.2 – 0.5 Check IV line ↑remifentanil ↓remifentanil ↑remifentanil ↓remifentanil


    mcg/ml Optimize analgesia! 1-2 ng/ml 1-2 ng/ml 1-2 ng/ml 1-2 ng/ml
    Imminent Awakening
    NO YES • Crystalloid infusion
    • Vasopressor Atropine
    c

    0.01mg/kg
    ↑ES 0.5 mcg/ml 50 mg bolus OR ↑ES mcg/ml
    Schnider 3 / Eleveld 1

    Emergence Remifentanil ES 2 – 3 ng/ml


    Propofol ES mcg/ml Reversal NMB /
    Schnider: 1 -1.5 3-5 min before end Sx TOF
    Eleveld: 1.5 – 2 until extubation
    For last skin sutures • Better hemodynamic, < Bucking
    http://tinyurl.com/
    TCIbasico
    Clinical case
    • Adult
    • 66 year old
    • Male
    • Weight: 70 kg
    • Height: 163 cm

    • BRAIN MRI

    • PROPOFOL TCI
    Clinical case
    • Adult
    • 30 year old
    • Male
    • Weight: 77 kg
    • Height: 168 cm

    • Sx: laparoscopic cholecystectomy

    • TIVA: PROPOFOL/REMIFENTANIL – CISATRACURIUM BOLUSES


    [email protected]

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