Effect Site Concentration During Propofol TCI Sedation: a Comparison of Sedation Score with Two Pharmacokinetic Models

Target controlled infusion (TCI) pumps function using a programme based on a pharmacokinetic/pharmacodynamic model. We compared the Marsh and Schnider models to find out which better correlates with the clinically observed effect of propofol as assessed by the Observer Assessment of Alertness/Sedation (OAAS) score and the Bispectral index. We assessed the sedation score and Bispectral index score in 40 un-premedicated patients undergoing surgical procedures under spinal anaesthesia with propofol sedation to a target concentration of 2 microg.ml(-1). Half of the patients received TCI propofol driven by the Schnider model in effect site control, the other half were sedated with TCI propofol driven by the Marsh model in plasma control. We calculated the effect site concentration predicted by both models for all the patients. Changes in the sedation score and Bispectral index correlated better with the Marsh than with the Schnider effect site prediction in both study groups.