Anuwar, Ahmad
(2008)
A comparative study between a target
controlled infusion (TCI) and manual
controlled infusion (MCI) of propofol
for sedation during cerebral
protection in severe traumatic brain
injured patients.
Masters thesis, Universiti Sains Malaysia.
Abstract
Propofol is the commonest sedative agent used in traumatic brain injured (TBI) patient
using manual controlled infusion (MCI) technique. The development of target controlled
infusion (TCJ) technique has given a new dimension of propofol administration and it has
never been tested in TBI patients. The aims of this study were to compare the
effectiveness of different method of propofol infusion (TCI versus MCI) for sedation
during cerebral protection in TBI patient in Neurosurgical Intensive Care Unit (NICU).
Methodology
In this prospective, double blinded, randomized controlled trial study, 50 patient who had
traumatic brain injury with a Glasgow Coma Scale (GCS) between 3 to 8, age between 16
to 50 years old with no severe medical illness and undergoing craniotomy were
randomized into two groups using block randomizations (25 patients in each group).
However, one of the patients in MCI group had to be excluded due to very agitated state
in spite of adequate sedation until the extend requiring muscle relaxant. During surgery,
both groups received anesthesia with a standard protocol and the study started once
patients admitted to Neuro ICU for cerebral protections. Sedations level was monitored
using Bispectral index (BIS) monitor and Sedation Agitation Scale (SAS). BIS index of
60-70 and SAS score of 2-3 was considered as adequate sedation. Both groups used the
same infusion pump which can operate either TCI or MCI and the drugs administrated
via a dedicated central venous line lumen. Homodynamic parameters (blood pressure
and heart rate ) and neurological parameters (intracranial pressure and cerebral perfusion
pressure) were recorded, time and volume used to achieve BIS 70, total volume of
propofol used for 24 hours and time taken to achieve BIS 90 after stopping infusion at the
end of cerebral protection were measured. Fentanyl infusion at 1 meg/kg were given for
pain relieve and was stopped four hours before the end of the study (24 hours).
Results
There are some significant differences between two modes of infusion. TCI mode
achieved SIS 60-70 significantly faster than MCT with mean time 6.32 ± 2.88 minutes
compared to MCI which is 19.71 ± 7.00 minutes. Time taken to recover from sedation to
achieving BIS 90 was also significantly faster in TCI at 22.44 ± 11.50 minutes compared
to MCI 57.29 ± 19.89 minutes. In view ofiCP, there was a significant difference between
two modes but no significant difference in MAP and CPP
Conclusion
TCI mode of propofol is more effective in sedating neurotrauma patients as gives
adequate sedation faster with a lesser volume and also faster recovery. It also lowers the
Intracranial pressure (ICP) to less than 20rnmHg better than MCI.
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