الفهرس | Only 14 pages are availabe for public view |
Abstract Introduction Patients undergoing TIPS are medically complex as a result of chronic liver disease causing multisystem physiological disruption. They should receive multidisciplinary preoperative assessment and optimization before undergoing the procedure Complexities of remote site, where the care administration is in an unfamiliar environment with considering staff and equipment availability. Sedation can be used to avoid the need for general anesthesia, using combinations of short acting sedative agents. The choice of drugs demand consideration of the physiological and pharmacokinetic changes seen in chronic liver disease patients. Target-controlled infusion (TCI), is an intravenous administration system, which provides desired target plasma concentrations of therapeutic agents and aims to maintain an appropriate depth of anesthesia. TCI has become increasingly popular in clinical practice, due to its ability to maintain more consistent plasma concentrations with fewer fluctuations. Aim of the study The purpose of this study was to compare the quality of sedation during transjagular intra hepatic portosystemic shunt procedural with propofol using target-controlled infusion versus manual infusion regarding sedline score, hemodynamics, recovery pattern, and patient and radiologist satisfaction. Patients and methods: This prospective randomized controlled study was performed on 78 ASA II patients enrolled for TIPS procedure. They received propofol infusion for sedation using target-controlled infusion or manually. The target-controlled infusion group (n = 38) received propofol with the target controlled infusion system (march‘s model) with the initial target plasma concentration set at 4 μg ml−1in patients over 50 years old and 5 μg ml−1 in patients under 50 years old with a bolus over 10 min. The manual infusion group (n = 38) received propofol manually in a bolus of 1 mg kg−1 over 10 min, then infusion (170 µg/ kg/min) for 10 minutes and then (130 µg/kg/min) for other 10 minutes in maintenance doses of (100 µg/kg/min), In both groups, the anesthesiologist adjusted to increase or decrease the infusion rate according to sedline score and hemodynamics. We recorded the amount of propofol, hemodynamics, sedline scores, patient‘s and radiologist‘s satisfaction, recovery time, and side effects. |