Zusammenfassung.
Die Entwicklung der intravenösen Anästhesie wurde in jüngster Zeit maßgeblich durch die Technik der Target Controlled Infusion (TCI) beeinflußt, die darüber hinaus noch weitere klinisch interessante Anwendungsmöglichkeiten in der perioperativen Medizin bietet. Die Markteinführung des „DiprifusorTM” als erstes kommerziell verfügbares TCI System für Propofol kann als Meilenstein einer erfolgreichen Forschungstätigkeit während der letzten Dekade gelten, welche die pharmakokinetischen Grundlagen der Computer unterstützten intravenösen Anästhesie begründete. Gegenwärtig befinden wir uns in einer Phase, in der TCI Technologie nicht mehr nur forschenden Spezialisten und Enthusiasten vorbehalten ist, sondern vielmehr anfängt, ein Teil der klinischen Routine zu werden. Die vorliegende Übersicht beschreibt die pharmakokinetischen Grundlagen der TCI Entwicklung, vorläufige klinische Erfahrungen, und diskutiert technische Aspekte hinsichtlich Pumpen- und Modellgenauigkeit und mögliche Anwendungsprobleme in der Praxis. Darüber hinaus werden neue Konzepte der patienten-kontrollierten Applikation von Sedativa und Analgetika auf der Basis von TCI vorgestellt.
The technique of target controlled infusion (TCI) has influenced the development of intravenous anaesthesia substantially and opens the possibility of many new and exciting applications in peri-operative anaesthetic care. The launch of „DiprifusorTM” as the first commercially available TCI system for propofol was the cornerstone of a successful research period within the last decade, which evaluated the pharmacokinetic foundations of computer assisted intravenous drug delivery. We are now in a period where TCI technology is becoming a part of routine anaesthesia technique for the practitioner rather than a research tool for specialists and enthusiasts. This review gives an update on the rational pharmacokinetic basis of TCI development, the preliminary clinical experience with the new technique, the performance and accuracy of TCI devices and potential technical pitfalls in clinical routine. Besides clinical application in anaesthesia with „Diprifusor®” TCI, target controlled systems are expected to play a significant role as research tools in the evaluation of drug interactions in anaesthesia and in the development of novel control techniques for the administration of sedative and analgesic drugs in the peri-operative period.
Schlüsselwörter:
Intravenöse Anästhesie - Propofol - Alfentanil - Remifentanil - Computer - Target Controlled Infusion
Key words:
Anaesthesia, intravenous - Anaesthetics, intravenous, propofol - Analgesics, alfentanil, remifentanil - Computer, target controlled infusion
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Dr. Stefan Schraag
Universitätsklinik für Anästhesiologie
Universitätsklinikum Ulm
Steinhövelstraße 9
D-89075 Ulm
Email: stefanschraag@compuserve.com
