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Anomalies in target‐controlled infusion: an analysis after 20 years of clinical use
Author(s) -
Engbers F. H. M.,
Dahan A.
Publication year - 2018
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.14212
Subject(s) - medicine , pharmacokinetics , dosing , intensive care medicine , extrapolation , clinical practice , variety (cybernetics) , target controlled infusion , medical physics , pharmacology , computer science , artificial intelligence , mathematical analysis , propofol , mathematics , family medicine , remifentanil
Summary Although target‐controlled infusion has been in use for more than two decades, its benefits are being obscured by anomalies in clinical practice caused by a number of important problems. These include: a variety of pharmacokinetic models available in open target‐controlled infusion systems, which often confuse the user; the extrapolation of anthropomorphic data which provokes anomalous adjustments of dosing by such systems; and the uncertainty of regulatory requirements for the application of target‐controlled infusion which causes uncontrolled exploitation of drugs and pharmacokinetic models in target‐controlled infusion devices. Comparison of performance of pharmacokinetic models is complex and mostly inconclusive. However, a specific behaviour of a model in a target‐controlled infusion system that is neither intended nor supported by scientific data can be considered an artefact or anomaly. Several of these anomalies can be identified in the current commercially available target‐controlled infusion systems and are discussed in this review.