Effect Site Concentration of Entropy Targeted TCI Propofol Anaesthesia in Patients Undergoing Surgery for Breast Cancer: Analysis in a Tertiary Cancer Centre

Abstract

Author(s): Nived kuzhichali, Jashma Chandveettil*, Riyas Malodan and Vijina

Background and Aims: Total Intravenous Anaesthesia (TIVA) is a method used for delivering anaesthesia since 1932. In TIVA, during Target-Controlled Infusion (TCI), the Effect-site concentration of drugs is derived from studies done in western volunteers. The targeted concentration of the drug developed on the pharmacokinetics of the western study population may not match with the Indian population. Our study was an attempt to analyse the targeted concentration of propofol in our patients who underwent Entropy targeted TCI propofol anaesthesia using a Schnider model in ablative surgeries for breast cancer.

Material and Methods: A Retrospective Observational study was conducted in a tertiary cancer centre after the protocol was approved by the Institutional Review Board. All patients who underwent surgeries for carcinoma breast during the period from March 2019 to August 2019 were included in the study.

Results and Conclusions: Thirty-one patients were included. The mean Effectsite concentration of propofol for maintaining the target Entropy of 40- 60 was 3.51 ± 0.58 microgram/ml (95% CI=3.30-3.73). Non-Depolarising Muscle relaxant was given during the maintenance phase after induction in patients who moved during skin incision (77.4%) to achieve an optimal plane of anaesthesia. During TCI Propofol for the optimal plane for surgical procedures, opioid or Non-Depolarising Muscle Relaxant may be used in the maintenance phase and depth of anaesthesia to be monitored as well by pEEG. Further study with a larger sample size using TCI with propofol and opioids is needed to find the Effect-site concentration during maintenance using Schnider model pharmacokinetics.

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