Anaes Cases · TIVA & target-controlled infusion
TIVA line disconnection and awareness
Hot case — TIVA disconnection. Propofol infusing into the bed; patient lightens; awareness risk. Reconnect; bolus; BIS monitoring; line security.
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ANZCAFRCAABAEDAIC
Prompt
During TIVA, the BIS rises from 45 to 85 and the patient moves. The propofol line is found disconnected. Manage.
Presentation
During prolonged spine surgery under TIVA (propofol TCI 3.5 mcg/mL effect-site + remifentanil 4 ng/mL), the BIS suddenly rises from 45 to 85, the heart rate increases from 60 to 90, and the patient moves. On inspection, the propofol infusion line is found disconnected from the IV access (propofol infusing into the bed). Manage.
[1]References1ShowHide
- [1]Keresztes M, et al. Target-Controlled Infusion for Caesarean Delivery Under General Anesthesia: From Conventional Pharmacokinetic Models to Physiologically Based Pharmacokinetic Modeling. Life, 2026.PMID 42195295