Printer Friendly

Another cause of leak during propofol target controlled infusion.

We read with interest the report by Sultana (1). We recently encountered a similar problem during the anaesthetic management of a 48-year-old patient with frontal meningioma. Anaesthesia was induced and maintained with propofol at a target plasma concentration of 2.5 [micro]g/ml using a target-controlled infusion (TCI) (Infusion workstation Frasenius vial, Brezins, France), which we adjusted to achieve a Bispectral index (BIS) of 40-45. Fentanyl and vecuronium boluses were also administered. We were surprised by a sudden rise of BIS from 45 to 73 during approximation of his scalp for closure, approximately five hours into the surgery, despite the EMG value remaining at 30. Suspecting an inadequate plane of anaesthesia due to the sudden increase in the surgical stimulus, a bolus of 25 mg propofol was set to be delivered immediately. However, we noticed that propofol had started to trickle down the base of the TCI pump, despite no alarm display. We then identified a leak from the joint of a proximally placed three-way tap, used to deliver boluses of drugs. We immediately replaced the three-way tap and administered a further bolus of propofol. This promptly restored the BIS to the required value.

We agree with the observation of Sultana regarding the routine pre-use check, but we would like to emphasise that other leaks can still occur and that continued vigilance is essential throughout the operation of a TCI pump. We also wish to highlight the use of monitors such as the BIS to facilitate early detection of such problems and to help prevent awareness.




Kerala, India


(1.) Sultana A. TIVA: Have you performed a leak test? Anaesth Intensive Care 2007; 35:303-304.

(2.) Laurent S, Fry R, Nixon C. Serial failure of Diprifuser infusion pumps. Anaesthesia 2001; 56:596-597.
COPYRIGHT 2007 Australian Society of Anaesthetists
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2007 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Correspondence
Author:Sriganesh, K.; Suneel, P.R.; Dash, P.K.
Publication:Anaesthesia and Intensive Care
Article Type:Clinical report
Geographic Code:9INDI
Date:Aug 1, 2007
Previous Article:Australian and New Zealand guidelines for preoperative fasting.
Next Article:Comparative safety and efficacy of two high dose regimens of oral paracetamol in healthy adults undergoing third molar surgery under local...

Related Articles
Remifentanil vs. lignocaine for attenuating the haemodynamic response during rapid sequence induction using propofol: double-blind randomised...
Closed-loop anaesthesia delivery system (CLADS[TM]) using bispectral index: a performance assessment study.
Impact of bispectral index monitoring on propofol administration in patients undergoing cardiopulmonary bypass.
In vitro effects of propofol on gravid human myometrium.
Effect of open-chest surgery in the lateral position on blood propofol concentration during target-controlled infusion of propofol.
Dose requirements for propofol anaesthesia for dental treatment for autistic patients compared with intellectually impaired patients.
Tropisetron plus subhypnotic propofol infusion is more effective than tropisetron alone for the prevention of vomiting in children after...
The use of "ketofol" (ketamine-propofol admixture) infusion in conjunction with regional anaesthesia.
Dose-related effect of propofol on pancreatic enzymes and triglyceride levels in patients undergoing non-abdominal surgery.

Terms of use | Privacy policy | Copyright © 2018 Farlex, Inc. | Feedback | For webmasters