Comparison of target-controlled infusion and manual infusion for propofol anaesthesia in children

Background: One major criticism of prolonged propofol-based total i.v. anaesthesia (TIVA) in children is the prolonged recovery time. As target-controlled infusion (TCI) obviates the need to manually calculate the infusion rate, the use of TCI may better match clinical requirements, reduce propofol dose, and shorten recovery time. Methods: Children of ASA grade 1, aged 1-12 yr, were recruited and randomly assigned to TCI or manual infusion. Children in the TCI group had propofol delivered by TCI. Children for manual infusion had a loading dose of 2.5 mg kg(-1) with subsequent infusion rates of 15, 13, 11, 10, and 9 mg kg(-1) h(-1). Attending anaesthesiologists adjusted the propofol dosage to keep the Bispectral Index (TM) (BIS) between 40 and 60. Results: Seventy-four children completed the study. The time taken to extubate the trachea after cessation of propofol was 15.1 (5.5) and 16.2 (6.1) min for children who had TCI and manual infusion, respectively (P=0.42). The mean propofol infusion rate was 16.7 [standard deviation (SD) 4.2] mg kg(-1) h(-1) in the TCI group and 14.6 (3.1) mg kg(-1) h(-1) in the manual infusion group (P = 0.036). The percentage of time when BIS was >60 was significantly lower in the TCI than the manual infusion group [10.2% (18.4%) vs 23.2% (26.3%), P=0.016]. Discussion: Use of TCI led to higher propofol doses but not prolonged recovery time in children compared with manual infusion. It was associated with a greater percentage of time when the BIS was in the desired range and it may be an easier method for titration of propofol administration during anaesthesia or sedation.