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The Safety of Target-Controlled Infusions

Schnider, Thomas W. Prof. Dr. med.*†; Minto, Charles F. MBChB, PhD, FANZCA; Struys, Michel M. R. F. MD, PhD, FRCA (Hon)§‖; Absalom, Anthony R. MBChB, FRCA, MD (UCT)§

doi: 10.1213/ANE.0000000000001005
Anesthetic Pharmacology: Review Article

Target-controlled infusion (TCI) technology has been available in most countries worldwide for clinical use in anesthesia for approximately 2 decades. This infusion mode uses pharmacokinetic models to calculate infusion rates necessary to reach and maintain the desired drug concentration. TCI is computationally more complex than traditional modes of drug administration. The primary difference between TCI and conventional infusions is that TCI decreases the infusion rate at regular intervals to account for the uptake of drug into saturable compartments. Although the calculated infusion rates are consistent with manually controlled infusion rates, there are concerns that TCI administration of IV anesthetics could introduce unique safety concerns. After approximately 2 decades of clinical use, it is appropriate to assess the safety of TCI. Our aim in this article was to describe safety-relevant issues related to TCI, which should have emerged after its use in millions of patients. We collected information from published medical literature, TCI manufacturers, and publicly available governmental Web sites to find evidence of safety issues with the clinical use of TCI. Although many case reports emphasize that IV anesthesia is technically more demanding than inhaled anesthesia, including human errors associated with setting up IV infusions, no data suggest that a TCI mode of drug delivery introduces unique safety issues other than selecting the wrong pharmacokinetic model. This is analogous to the risk of selecting the wrong drug with current infusion pumps. We found no evidence that TCI is not at least as safe as anesthetic administration using constant rate infusions.

Published ahead of print October 29, 2015

From the *Department of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, Switzerland; University of Berne, Bern, Switzerland; Department of Anaesthesia, North Shore Private Hospital, Hunters Hill Private Hospital, Westmead Private Hospital, Sydney Adventist Hospital, Sydney, Australia; §Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and Department of Anesthesia, Ghent University, Ghent, Belgium.

Accepted for publication July 27, 2015.

Published ahead of print October 29, 2015

Funding: This study received no external funding.

Conflict of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to Thomas W. Schnider, Prof. Dr. med., Klinik für Anästhesiologie, Intensiv-, Rettungs-und Schmerzmedizin, Rorschacher Strasse 95, CH-9007 St.Gallen, Switzerland. Address e-mail to

© 2016 International Anesthesia Research Society