Newly Published
Review Article  |   March 2019
Practicalities of Total Intravenous Anesthesia and Target-controlled Infusion in Children
Author Notes
  • From the Department of Anaesthesiology, University of Auckland, Auckland, New Zealand (B.J.A.), and the Department of Anaesthesia, Birmingham Women’s and Children’s Hospital, Birmingham, United Kingdom (O.B.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication March 15, 2018. Accepted for publication January 21, 2019.
    Submitted for publication March 15, 2018. Accepted for publication January 21, 2019.×
  • Correspondence: Address correspondence to Prof. Anderson: Department of Anaesthesiology, University of Auckland, Park Road, Grafton, New Zealand. briana@adhb.govt.nz. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Review Article / Pediatric Anesthesia
Review Article   |   March 2019
Practicalities of Total Intravenous Anesthesia and Target-controlled Infusion in Children
Anesthesiology Newly Published on March 26, 2019. doi:10.1097/ALN.0000000000002657
Anesthesiology Newly Published on March 26, 2019. doi:10.1097/ALN.0000000000002657
Abstract

Propofol administered in conjunction with an opioid such as remifentanil is used to provide total intravenous anesthesia for children. Drugs can be given as infusion controlled manually by the physician or as automated target-controlled infusion that targets plasma or effect site. Smart pumps programmed with pharmacokinetic parameter estimates administer drugs to a preset plasma concentration. A linking rate constant parameter (keo) allows estimation of effect site concentration. 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). Propofol validation studies suggest that these parameter estimates are satisfactory for the majority of children. 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. 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.