Propofol Target-Controlled Infusion (TCI) vs. Manual-Controlled Infusion (MCI)—Comparable Hemodynamic Stability with Reduced Propofol Consumption: Randomized Clinical Trial

Abstract

Background: The procedure of endoscopic retrograde cholangiopancreatography (ERCP) requires deep sedation for procedural success and patient safety. Propofol is commonly used due to its rapid onset and recovery, but its administration method significantly impacts its effectiveness and safety. This study compares Target Controlled Infusion (TCI) and Manual Controlled Infusion (MCI) of propofol in ERCP patients. Methods: A single-blind randomized controlled trial was conducted with 22 ERCP patients, who were randomly assigned to either the TCI group (n=11) or the MCI group (n=11). In the TCI group, propofol was administered using the Schnider pharmacokinetic model, targeting effect sites, with an initial effect-site concentration set at 2.5 mcg.kg-1. In contrast, the MCI group received an initial propofol bolus of 2 mg.kg-1, followed by 20 mg increments every 10 seconds. The study analyzed propofol induction time, hemodynamic stability, and total propofol consumption, with hemodynamic parameters recorded every five minutes. Results: The TCI group had a significantly longer induction time (10.00 ± 2.05 min vs. 3.45 ± 1.21 min; p < 0.001) but required a lower total dose of propofol (2.30 ± 0.43 mg.kg-1.h-1 vs. 3.69 ± 0.69 mg.kg-1.h-1; p < 0.001). Hemodynamic stability was comparable between both groups. Conclusion: TCI provides similar hemodynamic stability to MCI while reducing total propofol consumption. Despite a longer induction time, TCI may be a more cost-effective and controlled method for propofol administration in ERCP

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