Target Controlled Infusion in obese patients

Target-Controlled Infusion (TCI) allows achieving a selected blood concentration of intravenous anesthetic drugs and titrating this target based on patient's individual requirements during general anesthesia or sedation. Dosing is linked to target concentrations using a published pharmacokinetic model. These models are influenced by age, gender or obesity. While the first models used for TCI were developed in young and thin patients, subsequent models were either adjusted for age, weight or lean body mass, or developed for restricted populations (children, obese…). Recently, “universal” models suitable for all types of patients were developed. Clinical use of these models that are now commercially available, should offer a more than never accurate titration adapted to the patient and the procedure (especially in specific cohorts such as obese patients) and ease of use for the caregivers. This short update recalls the principles of TCI, the obesity specificity and describes the current and future models available for TCI of propofol, remifentanil and sufentanil.