Abstract
During the past decade, major advances have taken place with regard to intravenous infusion anaesthesia. New opioid analgesics, iv anaesthetics, and muscle relaxants have become available, which are characterized by a rapid onset of action, short duration of clinical effect, and favourable side effect profiles. Optimal administration of these drugs is often best achieved by continuous infusion, rather than a more traditional technique of intermittent bolus administration. New concepts in pharmacokinetic modelling also provide an enhanced appreciation of the factors which determine rates of recovery upon discontinuation of an intravenous infusion. Pharmacokinetic principles guide rational selection of the iv anaesthetic drugs according to both procedure and patient-specific requirements. In addition, improvements in the new programmable syringe infusion pumps provide a degree of simplicity and accuracy in operation, which make iv infusion of one, two or three components of the anaesthetic state a simple and practical reality for most procedures. In this CME article, these issues will be reviewed according to the following outline: Historical considerations; Rationale for continuous infusion of iv anaesthetic drugs; Pharmacokinetic and pharmacodynamic considerations; Infusion schemes; New techniques, new indications; IV anaesthetic delivery systems; Pharmacoeconomic considerations; Conclusions.
Résumé
Au cours de la dernière décennie, l’anesthésie intraveineuse par perfusion continue a réalisé des progrès considérables. De nouveaux analgésiques morphiniques, agents iv et myorelaxants ont vu le jour. Ces produits sont caractérisés par un début d’action rapide, des effets de courte durée et un profil d’effets secondaires favorable. L’administration optimale de ces drogues est souvent réalisée par perfusion continue plutôt que par la technique traditionnelle des bolus intermittents. Les derniers modèles pharmacocinétiques assurent une meilleure évaluation des facteurs qui déterminent la vitesse de récupération après l’arrêt de la perfusion intraveineuse. Les principes pharmacocinétiques dirigent la sélection rationnelle de l’anesthésique iv adaptée à l’intervention et aux besoins spécifiques du patient. De plus, les améliorations apportées aux nouveaux pousseseringue programmables assurent simplicité et précision pour le contrôle par perfusion iv d’une, de deux ou des trois composantes de l’état anesthésique pour la plupart des interventions. Dans cette mise à pur, ces sujets seront traités sous le schéma suivant: Historique; Rationnel de la perfusion iv continue d’anesthésiques; Considérations pharmacocinétiques et pharmacodynamiques; Plans de perfusion; Nouvelles techniques, nouvelles indications; Systèmes d’administration iv d’anesthésiques; Considération pharmacoéconomiques; Conclusions.
Article PDF
Similar content being viewed by others
References
Pico LJ, An appliance to facilitate the administration of intravenous anaesthesia by continuous drip. Anesthesiology 1944; 5: 411–2.
Lowenstein E. Morphine “anesthesia” — a perspective. Anesthesiology 1971; 35: 563–5.
White PF. Use of a continuous infusion versus intermittent bolus administration of fentanyl or ketamine during outpatient anesthesia. Anesthesiology 1983; 59: 294–300.
Shafer SL, Varvel JR. Pharmacokinetics, pharmacodynamics, and rational opioid selection. Anesthesiology 1991; 74: 53–63.
Hughes MA, Glass PSA, Jacobs JR. Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anesthesiology 1992; 76: 334–41.
Egan TD, Lemmens HJM, Fiset P, et al. The pharmacokinetics of the new short-acting opioid remifentanil (G187084B) in healthy adult male volunteers. Anesthesiology 1993; 79: 881–82.
Scott JC, Ponganis KV, Stanski DR. EEG quantitalion of narcotic effect: the comparative pharmacodynamics of fentanyl and alfentanil. Anesthesiology 1985; 62: 234–41.
Wagner JG. A safe method for rapidly achieving plasma concentration plateaus. Clin Pharmacol Ther 1974; 16: 691–700.
Miller D, Martineau R, Dean D Midazolam infusion for conscious sedation following abdominal aortic surgery: dose requirements and recovery characteristics. Anesthesiology 1992; 77: A269.
Martineau RJ, St. Jean B, Kitts JB, et al. Cumulation and reversal with prolonged infusions of atracurium and vecuronium. Can J Anaesth 1992; 39: 670–6.
Glass PSA, Jacobs JR, Smith LR, et al. Pharmacokinetic model-driven infusion of fentanyl: assessment of accuracy. Anesthesiology 1990; 73: 1082–90.
Sevan DR. Anaesthesia pharmacoeconomics (Editorial). Can J Anaesth 1993; 40: 693–5.
Sung Y-F, Reiss N, Tillette T. The differential cost of anesthesia and recovery with propofol-nitrous oxide anesthesia versus thiopental sodium-isoflurane-nitrous oxide anesthesia. J Clin Anesth 1991; 3: 391–4.
Torsher L, Martineau RJ, Tierney M, Hopkins HS, Miller DR. A survey of anaesthetic drug expenditures. Can J Anaesth 1992; 39: A113.
Rathmell JP, Brooker RF, Prielepp RC, Butterworth JF 4th,Gravlee GP. Hemodynamic and pharmacodynamic comparison of doxaxurium and pipercuronium with pancuronium during induction of cardiac anesthesia: does the benefit justify the cost? Anesth Analg 1993; 76: 513–9.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Miller, D.R. Intravenous infusion anaesthesia and delivery devices. Can J Anaesth 41, 639–652 (1994). https://doi.org/10.1007/BF03010006
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03010006