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To induce general anesthesia, propofol is the drug used almost exclusively, having largely replaced sodium thiopental. [13]It is often administered as part of an anesthesia maintenance technique called total intravenous anesthesia, using either manually programmed infusion pumps or computer-controlled infusion pumps in a process called target controlled infusion (TCI).
Propofol-based TIVA significantly improves post-operative recovery profile and comfort, minimizes nausea and vomiting, facilitates rapid recovery, greater hemodynamic stability, preservation of hypoxic pulmonary vasoconstriction, reduction in intracerebral pressure, and reduces the risk of organ toxicity. [14]
Propofol infusion syndrome (PRIS) is a rare syndrome which affects patients undergoing long-term treatment with high doses of the anaesthetic and sedative drug propofol. It can lead to cardiac failure , rhabdomyolysis , metabolic acidosis , and kidney failure , and is often fatal.
A V D greater than the total volume of body water (approximately 42 liters in humans [5]) is possible, and would indicate that the drug is highly distributed into tissue. In other words, the volume of distribution is smaller in the drug staying in the plasma than that of a drug that is widely distributed in tissues.
It provides no analgesia, so it was commonly used with fentanyl for effective PSA prior to propofol and etomidate. Midazolam collects in the body's fatty tissues, so a possible complication includes prolonged sedation. As a result, the elderly, the obese, and those with kidney or liver disease are more vulnerable to prolonged sedation with ...
Initially the drug present in central compartment (i.e. circulation system) is being distributed into the tissues, and being eliminated; At steady state, the concentration of free drug in the central compartment (i.e. circulation system) is equal to the concentration of free drug in the peripheral compartment (i.e. body tissues)
After the anesthetist sets the desired parameters in a computer and presses the start button, the system controls the infusion pump, while being monitored by the anesthetist. [1] TCI is as safe and effective as manually controlled infusion. [2] [3] TCI can be sub-classified according to the target.
In a retrospective review of almost 32,000 people, etomidate, when used for the induction of anaesthesia, was associated with a 2.5-fold increase in the risk of dying compared with those given propofol. [37] People given etomidate also had significantly greater odds of having cardiovascular morbidity and significantly longer hospital stay. [37]