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Intraoperative neuromonitoring (IONM) has improved the safety of neurosurgical procedures but relies on avoiding volatile anaesthesia. Total intravenous anaesthesia (TIVA) for patients younger than one year is not possible using existing target-controlled infusion (TCI) devices. Applying the TCI pumps’ pharmacokinetic (PK) models outside of their reference populations will lead to inaccurate dosing and is not recommended. PK models applicable for infants have been described and can be applied clinically using pharmacokinetic simulation software and advisory displays (e.g. Stelsim1). The technique comprises tracking a manually controlled infusion regimen in real time while displaying the estimated blood and effect-site concentrations, thereby assisting the clinician to maintain stable drug concentrations and stable drug effect. The method also enables titration of drug dosage to the patient requirements and facilitates timely emergence and extubation. We call the technique “target guided infusion (TGI)”.

southern african journal of anaesthesia and analgesia

Anaesthetic management of a three-month-old baby for cervical limited dorsal myeloschisis repair using propofol and alfentanil infusions guided by pharmacokinetic simulation software: A case report