Anesthésie intraveineuse à objectif de concentration de morphinique en pratique clinique

Target controlled infusion (TCI) aims to choose a plasma or brain concentration and determine the corresponding doses to be administered through an appropriate pharmacokinetic model. TCI systems are available for propofol, sufentanil and will be very soon for alfentanil. TCI does not change the pharmacokinetic and pharmacodynamic properties of the drugs used, but makes it easier to achieve the minimal required concentration allowing decreasing the incidence of side effects and acute tolerance to opioid. The choice of the target depends on the surgical nociceptive stimulations, the patient, the hypnotic/opioid balance and on the context (duration of the procedure, rapid recovery from anesthesia expected or not). During surgery, it must be assessed and titrated regularly.