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ANESTHETIC PHARMACOLOGY

Target-Controlled Versus Manually-Controlled Infusion of Propofol for Direct Laryngoscopy and Bronchoscopy

Sylvie Passot, MD^*, Frédérique Servin, MD, René Allary, MD^*, Jean Pascal, MD^*, Jean-Michel Prades, MD PhD, Christian Auboyer, MD^*, and Serge Molliex, MD PhD^*

*Département d’Anesthésie-Réanimation, Service d’ORL et de Chirurgie Cervico-Faciale et Plastique, Hôpital Bellevue, Saint-Etienne Cedex 2, France; and Département d’Anesthésie-Réanimation, Hôpital Bichat, Paris, France

Address correspondence and reprint requests to Sylvie Passot, Département d’Anesthésie-Réanimation, Hôpital Bellevue, 42055 Saint-Etienne Cedex 2, France. Address e-mail to sylvie.passot{at}chu-st-etienne.fr

Few studies have compared the clinical profile of target-controlled infusions of propofol with that of manually-controlled infusions. Fifty-four ASA physical status I or II patients scheduled for an elective otorhinolaryngology endoscopy performed under general anesthesia with spontaneous ventilation were enrolled in this prospective randomized study to compare the clinical outcome of such administrations. Before induction, all patients received a single alfentanil bolus dose (10 µg/kg). Propofol administration was adapted to maintain absence of movement, hemodynamic stability, and efficient spontaneous ventilation. When compared with the Manually-Controlled Infusion group, in the Target-Controlled Infusion group there were fewer movements at insertion of the laryngoscope (14.8% vs. 44.4%), improved hemodynamic stability (largest variations of mean arterial blood pressure <10% of control values, versus 20%), fewer episodes of apnea, and less respiratory acidosis after endoscopy (pH = 7.37 ± 0.05 and PaCO₂ = 50 ± 7 mm Hg versus pH = 7.28 ± 0.06 and PaCO₂ = 58 ± 9 mm Hg); the recovery was also shorter (time to opening eyes or verbal response, 4.6 ± 2.0 min and 6.8 ± 2.5 min versus 10.8 ± 7.3 min and 15.7 ± 7.1 min). Propofol consumption was comparable in the two groups. Targeting the effect-site concentration improved the time course of the propofol drug effect during direct laryngoscopy performed during spontaneous ventilation when compared with manual infusion.

IMPLICATIONS: This study compares the clinical profile of propofol anesthesia for direct laryngoscopy with spontaneous ventilation when the drug is administered either as a manually controlled infusion or by targeting the effect-site concentration through a target-controlled infusion (TCI) device. TCI improves the time course of propofol effects.

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