Simulation of Propofol Target-Controlled Infusion up to Time of Delivery in Cesarean Section: A Bench Study.

Background/

Objectives

General anesthesia is occasionally required for cesarean delivery (CD). Propofol target-controlled infusion (TCI) enables dosing based on pharmacokinetic modeling. During the transition from induction to maintenance, infusion pauses. This simulation study assessed propofol from induction to delivery and the proportion of deliveries estimated during this pause.

Methods

Surgical data from women undergoing CD were compiled, and the demographics were entered into a TCI pump using the Schnider model. Effect-site targets (6 and 8 mcg/mL) were simulated for induction, followed by 2.5 mcg/mL for maintenance. Outcomes were estimated propofol dose from induction to delivery and timing of delivery relative to infusion pause.

Results

Among 50 women, the estimated mean propofol dose from induction to delivery was 19 ± 22 mg (0.2 ± 0.3 mg/kg) at 6 mcg/mL and 13 ± 17 mg (0.2 ± 0.2 mg/kg) at 8 mcg/mL. Delivery occurred during the infusion pause in 40% and 50% of cases, and it was more often in emergency than elective procedures. Emergency status, but not age or body mass index, predicted delivery during the pause.

Conclusions

Standardized TCI with reduced effect-site targets for maintenance resulted in modest propofol administration between induction and delivery. These findings require confirmation in clinical studies, where dosing should be guided by depth-of-anesthesia monitoring.