Abstract:
Objective: To evaluate whether estimating propofol requirement before surgery using a target-controlled infusion (TCI) model-based algorithm could reduce waste whilst maintaining workflow.
Design: Retrospective cohort study with in silico TCI-TIVA simulations using the Eleveld model at fixed effect-site targets (Cet 2.5-4.0 μg.ml-1) or a Cet corresponding to an estimated BIS of 45 (ECBIS45). Monte-Carlo simulation examined uncertainty in surgical duration estimates.
Setting: University tertiary care provider.
Patients: 229 adult patients undergoing general anesthesia with conventional propofol TIVA with manually adjusted infusion rate.
Measurements: Primary endpoint: predicted propofol amount for TCI and waste associated with three drawing-up strategies (50 ml vial only, 20 ml vial only, and vial combination based on estimated requirements). Secondary endpoint: relative number of syringe changes.
Main results: Propofol requirements predicted using Cet 3.0 and ECBIS45 were similar to actual consumption. Algorithm-guided drawing-up produced significantly lower predicted waste than conventional TIVA practice (p < 0.0001, CI = -61.0 to -27.0 mg/procedure for Cet 3.0; p = 0.001, CI = -60.0 to -26.7 mg/procedure for ECBIS45), comparable to the 20 ml vial-only strategy but requiring fewer syringe changes. Waste remained significantly lower despite surgical duration estimation errors up to 20% for Cet 3.0 (p = 0.007) and 30% for ECBIS45 (p = 0.01).
Conclusions: Using the Eleveld TCI model to estimate pre-operative propofol requirements could significantly reduce waste and avoid excessive syringe changes, even when surgical duration is uncertain.
Reference:Windler F, Zhong G, Coburn M, Xu X, Piekarski F, Kruse P, Bette B, Siegert P. Reducing propofol waste during TIVA by pre-operative estimation of requirement: A single-center retrospective analysis. J Clin Anesth. 2026 Feb 19;110:112160. doi: 10.1016/j.jclinane.2026.112160. Epub ahead of print. PMID: 41719827.