Anaes · TIVA & target-controlled infusion
Effect-site targeting in clinical TIVA practice
Also known as Effect-site targeting · Effect-site TCI · ke0 and the effect compartment · Propofol-remifentanil TIVA · Clinical TIVA titration · Closed-loop anaesthesia
Effect-site targeting is the clinical refinement of target-controlled infusion that aims the pump at the brain rather than the plasma. By modelling the plasma-to-effect-site delay (ke0), it allows rapid, smooth induction and precise titration to a processed-EEG depth monitor — the practical basis of modern propofol-remifentanil TIVA, of shared-airway anaesthesia, and of emerging closed-loop systems.
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8 MCQs with explanations
Target exams
Red flags
Meet the patient
A 55-year-old man presents for robotic-assisted bronchoscopy under general anaesthesia. The bronchoscopist will occupy the airway throughout, so there is no endotracheal tube and no volatile circuit — you maintain anaesthesia with a propofol-remifentanil effect-site TIVA while the surgeon works through an open, shared airway. Every adjustment you make is a predicted brain concentration on a screen, and your only confirmation that the prediction matches reality is the processed-EEG trace and the patient's clinical signs.[2]
The two questions every effect-site TIVA stem turns on: is the predicted brain concentration producing the intended depth? (processed EEG, clinical signs) and is the target too high for this patient's haemodynamics? (the overshoot that drives the brain to target also depresses the blood pressure).[4]
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References6Show ledgerHide ledger
- [1]He ZY, et al. Comparison of propofol-remifentanil target-controlled infusion with lidocaine versus neuromuscular blockade for laryngoscopy Minerva Anestesiol, 2026.PMID 42267885
- [2]Stretch B, et al. Peri-operative care of patients undergoing robotic-assisted bronchoscopy under general anaesthesia - a single-centre retrospective cohort study Anaesth Rep, 2026.PMID 42283065
- [3]Felippe VA, et al. Closed-loop systems for automated hypnotic drug delivery during general anaesthesia: a systematic review and meta-analysis Br J Anaesth, 2026.PMID 42014224
- [4]Stojanovic M, et al. What's new in intravenous anaesthesia? Curr Opin Anaesthesiol, 2026.PMID 41677226
- [5]Newman D, et al. Reframing paradoxical excitation: disentangling electroencephalogram complexity and entropy reveals resting-state dynamics associated with propofol susceptibility in healthy adults Br J Anaesth, 2026.PMID 42225443
- [6]Kim HY, et al. Respiratory Depression Following Concomitant Infusion of Remimazolam and Remifentanil Using Targeted Effect-Site Concentrations: A Randomized Controlled Trial Medicina (Kaunas), 2026.PMID 42195193