Advantages of target concentration controlled intravenous anaesthesia

This is an automatically translated article.

The article was professionally consulted by Specialist Doctor II Nguyen Binh - Department of General Surgery - Vinmec Ha Long International Hospital. Doctor Nguyen Binh has more than 20 years of experience in the field of anesthesia and resuscitation.
Target concentration controlled intravenous anaesthesia is the mainstay of intravenous general anesthesia. Target concentration controlled intravenous anesthesia has many advantages over traditional methods. Patients experience fewer side effects and reduce the risk of drug toxicity. Anesthetics used in target-controlled intravenous anaesthesia include propofol, sufentanil, remifentanil, and alfentanil.

1. In what cases is the method of intravenous anesthesia with target concentration control applied?

Target concentration controlled intravenous anesthesia is a new method with many advantages for patients. This method is indicated in almost all cases. The advantages of targeted intravenous anesthesia are maximized in the following medical conditions:
Surgery for neurological diseases Pathologies that require the patient to restore nervous system activities Early oocyte aspiration Outpatient surgery, simple to perform and the patient to return within the same day Cases that assess the patient's potential for malignant hyperthermia during surgery Risk of nausea and vomiting high vomiting after surgery Surgery for diseases related to the thorax such as total pneumonectomy or lobectomy.

2. Fundamentals of Target Concentration Controlled Intravenous Anesthesia

To ensure the safety and effectiveness of anesthesia during surgery, the process of performing targeted intravenous anesthesia should adhere to the following basic principles:
Choosing the right drugs and using them dose appropriate for each patient. Anesthesiologists need to understand the pharmacokinetics and pharmacokinetics of drugs, ensure effective anesthesia targets and rapid anesthesia release. Closely monitor the patient's anesthesia and adjust the anesthetic depth in time when there are abnormalities. This is also a way to prevent and timely detect side effects from an overdose of anesthetics. The combination of appointing analgesics and antipsychotics continuously or intermittently depending on the patient's clinical situation. Maintain pain medication after surgery is over. Monitor the patient's vital indicators including pulse, blood pressure, temperature, urine. Promptly initiate fluid resuscitation with or without combination with vasopressors to restore normal values ​​if blood pressure falls. In contrast, use antihypertensive drugs when blood pressure is too high. Muscle relaxants need to be used in sufficient doses to ensure effective anesthesia during surgery.

3. Target concentration controlled intravenous anesthesia in some special cases

Overweight and obese patients Targeted concentration-controlled intravenous anesthesia is an appropriate choice for obese patients. However, the parameters fixed in the fixed control pump are not suitable for overweight people. The maximum weight limit is 150kg with maximum body mass index (BMI) ranging from 42-43 for male patients and 35-36 for female patients. The operating models of these devices are often built from the data of normal people, so they are not suitable for overweight people. Anesthetic drugs such as propofol are good fat-soluble substances, so a scary complication when administering anesthesia in obese patients is drug toxicity. While choosing an anesthetic, doctors will give preference to those with low fat solubility such as remifentanil to ensure patient safety. Besides, the method of endotracheal intubation without the use of muscle relaxants is not favorable in obese patients, so it is not a preferred choice.

Elderly Patients Elderly patients with multiple chronic medical conditions should always be the focus of attention when performing any procedure, including targeted-controlled intravenous anaesthesia. Kinetics and effects of drugs used in anesthesia such as sedatives, muscle relaxants, analgesia, anesthesia vary from patient to patient. Elderly patients have unpredictable drug responses and are considered susceptible to anesthesia. One of the most important considerations when administering targeted intravenous anesthesia is the control of stable drug concentrations in the machine. Do the math and start using the lowest effective anesthetic concentration and increase it gradually. Elderly patients should also be carefully monitored for blood pressure values. Systolic and diastolic blood pressure should be kept within the normal range, should avoid hypotension and not cause cerebral ischemia. The drug of choice for intravenous anesthesia in elderly patients is remifentanil because it stabilizes the patient's hemodynamic values.
Patients with regional anesthesia Indication of target concentration controlled intravenous anesthesia for patients with regional anesthesia because there are many suitable points such as:
Helps patients quickly sedation and also recover quickly after exiting Anesthesia The drug dose, plasma concentrations and its effects are well controlled Simple method of operation The patient experiences little pain because the pain is well controlled Intravenous anesthesia is controlled Target concentration control is a fairly common anesthetic technique in surgery, but to achieve the best results, patients must be treated by qualified and experienced doctors with a full system of medical equipment. , meet the requirements of surgical equipment.
Currently, Vinmec International General Hospital has a team of professors, doctors, doctors, ... leading in the surgical department who have successfully performed many surgeries, anesthesia and resuscitation. Besides, with modern equipment, complete facilities will bring the highest efficiency for treatment.
Especially, so that patients across the country can easily visit, now, Vinmec International General Hospital also deploys general health checkup packages, helping patients detect many diseases early. disease and get the best treatment.

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