Blog

Lost in LOC. Titrating to effect. What does it reveal? Dr. Hernán Boveri, Italian Hospital of Buenos Aires, Argentina. Saturday 20 January 9:00-9:30 Currently, propofol is the most widely used intravenous anesthetic drug capable of providing safe general anesthesia. Propofol can be administered using different techniques including target-controlled infusion (TCI).One of the greatest strengths of TCI technology lies in its ability to maintain the pharmacological condition once the predefined clinical effect has been achieved. TCI models were developed based on data from healthy volunteers and may not apply to all clinical situations, potentially resulting in under-dosing or overdosing both of which are adverse situations for patients. Individual variability in the pharmacokinetic parameters of anesthetics is a clinical challenge, as is pharmacodynamic variability. The large variation between patients in the concentration at the effect site that produces unconsciousness makes it difficult to establish the minimum concentration that provides effective sedation in a given patient. This would be of little importance if

The different models implemented in TCI:how it happend and who is responsible Stefan Schraag Saturday 10:30-11:00 Who safeguards PK models? It is a tricky task for most to develop a pharmacokinetic model. It gets even more difficult to publish one without any typos. And then, once you have achieved that, what to do with it and how? This is one of the questions surrounding the governance  of pharmacokinetic and pharmacodynamic research and scientific output when it informs medical device development and, ultimately, patient care. Since its inaugural incarnation in 1996, Target Controlled Infusion of propofol is such an example of a patient facing class 3 medical device supported by a pharmacokinetic model. Without going through the details of regulatory approval and post-market surveillance as demanded by the new Medical Device Regulations in Europe, I will discuss a few key questions that have been coming up over the last 25 years on TCI, its devices and model implementations. A great place

Why Total Intravenous Anaesthesia (TIVA) An overview on aspects of patient outcome, oncology, and the environment. Nick Sutcliffe Friday 19 January 8:30-9:00 Introduction The safety of surgery under anaesthesia has improved markedly over the last century. New drugs and improved equipment have resulted in more accurate dosing and reduced side effects. As mortality has improved, focus has shifted to also include non-lethal postoperative complications such as nausea, vomiting, pain, and cognitive dysfunction. Similarly, it is no longer sufficient to consider only immediate survival after surgery, but also longer-term issues such as cancer recurrence, quality of life and cognitive decline following surgery under anaesthesia.  Propofol based TIVA has several potential advantages over volatile based anaesthesia (VBA), for both the patient and operating room staff, as well as environmental benefits. Evidence is accumulating to support the use of TIVA over VBA, in terms of improved patient outcomes, less toxicity in the local environment and less effect on the global environment relating to

Multimodal anesthesia and multimodal sedation: is two times one more than two? Francisco Lobo Friday 19 January 10:30-11:00 The state of General Anesthesia comprises unconsciousness, amnesia, analgesia/antinociception and immobility accompanied by physiological stability. Classically, this drug-induced reversible state has been achieved with the use of basic interactions between hypnotic drugs, opioids and muscular relaxants; the current balanced general anesthesia is  usually based on an hypnotic drug for induction, volatile agent of intravenous drug for maintenance and opioids administered by boluses or as an infusion while muscle relaxation and paralysis may be achieved with the interaction between these drugs or supplemented by muscle relaxants. A new paradigm has been suggested involving more drugs than this basic triple cocktail. This multimodal general anesthesia approach is based on the ideas that: additional drugs acting in multiple neuronal pathways by different mechanisms may contribute to optimize the nociception-antinociception balance; the synergic and additive interactions between  different drugs at lower doses will decrease the side

time Friday 19 January presenter 08:00-8:15 Registration 08:15-08:30 Chairmans welcome, introduction and practical issues Alain Borgeat 08:30-09:00 Why TIVA? An overview on aspects of patient outcome, oncology, and the environment. Nick Sutcliffe 09:00-09:30 The Eleveld model dissected Extended in the afternoon workshop Hugo Vereecke 09:30-10:00 With a hammer everything looks like a nail How to use the tivatrainer? Frank Engbers 10:00-10:30 Coffee break 10:30-11:00 Multimodal anaesthesia and multimodal sedation: is two times one more than two? Francisco Lobo 11:00-11:20 Patient maintained sedation Smart pharmacologic concepts beyond the OR Gavin Kenny 11:20-12:00 Collected questions from attending and on-line participants and possible answers Faculty 12:00-17:00 Snow and sweat, up and down All Skiers Present 15:00-16:30 Workshop on-line: my first TIVA/TCI do’s and don’ts when beginning with TIVA/TCI I.e.: infusion line handling,TCI setup and control,drug and model selection,titrate with and without TCI Frank Engbers + NSF(Non Skiing Faculty) 17:00-18:30 workshops:Basic Pk ;Deep dive into the Eleveld model; Train the trainer. Faculty time Saturday

The Eleveld model dissected Prof. Dr. Hugo Vereecke, University of Groningen, The Netherlands Friday 19 January 9:00-9:30 In 2018, Douglas Eleveld, from the University of Groningen,  published a new PKPD model for propofol based on the “open TCI initiative” database.1 This database, initiated by S. Shafer and C. Minto, combined a large amount of raw data derived from previously published studies on the PKPD of propofol, remifentanil and some other drugs. By combining these  globally acquired data, including several  demographic subgroups of people, Eleveld developed a so called “general purpose” model for propofol,  a single PKPD model that can adjust the propofol administration towards predictable results in all types of patients, including lean and obese adults, elderly and children. As even the largest database may contain limited information on rare demographic characteristics, the model also incorporates mathematical solutions to avoid extreme deviations of drug administration in such patients. The first prospective validation studies reveal promising results.2 However, when switching from one TCI

Patient-Maintained Sedation Smart pharmacologic concepts beyond the OR Gavin NC Kenny Friday 19 January 11:00-11:30 Conscious sedation allows patients to undergo procedures which they would otherwise be unable to tolerate. The sedation must not contribute any morbidity or mortality to the procedure and ideally should be safe when used by surgeons and physicians as well as anaesthetists. Satisfactory sedation has been reported with TCI propofol in patients undergoing upper gastrointestinal endoscopy and surgery under regional blockade. Patient-maintained sedation (PMS) allows the patient to control the target concentration of propofol using a button push. Studies suggest that this provides rapid, safe and effective relief of anxiety. The requirement was to develop a system which cannot allow the patient to overdose. Recent studies demonstrated the feasibility of using degradation in patient reaction time as a control function. The use of reaction time to control the target concentration of propofol may increase the margin of safety during sedation. With more procedures being undertaken using

Multimodal monitoring to guide TIVA:more windows more light? Luc Barvais MD, PhD1 and Sean Coeckelenbergh, MD2 Saturday 20 January 8:30-9:00 Erasme University Hospital, Brussels Paul Brousse Hospital, Paris Improving TIVA by personalizing monitoring TCI titration is very important in the daily clinical anaesthesia practice to decrease the risk of agitation and sometimes delirium in the postoperative period which could be associated with postoperative cognitive dysfunction.  The aim of new TCI techniques is to get perfect recovery with patients walking rapidly after moderate to major surgery without any mental alteration. In an international survey published in 2022, the rate of responses was essentially in Europe with 255 respondents in Western Europe, 96 respondents in Southern Europe and 76 respondents in Eastern Europe (1).  The majority of respondents considered anaesthetic depth monitoring EEG either always or on most occasions important while a majority never or occasionally found antinociception monitoring important with a statistically significant difference.  The respondents use EEG monitoring more often during