GasGasGas - The FRCA Primary Exam Podcast GasGasGas - TIVA Models for Propofol TCI
Apr 24, 2025
The discussion dives into TIVA models for Propofol, specifically Marsh, Schneider, and Eleveld. Listeners learn the importance of understanding pharmacokinetic models over manual dosing for safety. Insights include how each model is developed, with a focus on their strengths and limitations. The episode emphasizes the need for careful dosing, particularly for obese patients, and offers practical tips on pump programming. There's a recommendation to treat TCI as a valuable tool rather than a definitive answer, ensuring tailored anaesthetic plans.
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What TCI Actually Does
- TCI uses pharmacokinetic models to predict plasma and effect-site drug concentrations and drive infusion pumps.
- Computers automate complex maths to achieve target concentrations more precisely than manual dosing.
Prefer Effect-Site Targeting For Faster Onset
- Use effect-site targeting when you want faster clinical onset because pumps will 'overpressure' plasma to speed equilibration.
- Expect an initial bolus then pause while plasma and effect site equilibrate.
Induction Vs Maintenance Weight Correlates
- Induction dose correlates better with lean body mass whereas maintenance rate correlates better with total body mass.
- Highly perfused tissues get bolus drug first, then fat takes up drug over time affecting maintenance.