Key result
Eleveld TCI model cuts predicted propofol waste up to ~61 mg without increasing syringe changes.
Why the study?
To evaluate whether estimating propofol requirement before surgery using a target-controlled infusion model-based algorithm could reduce waste while maintaining workflow.
Does pre-operative estimation of propofol requirement using a TCI model-based algorithm reduce propofol waste during TIVA?
Does pre-operative estimation of propofol requirement using a TCI model-based algorithm reduce propofol waste during TIVA?
Pre-operative estimation of propofol requirements using a TCI model can significantly reduce drug waste without increasing syringe changes.
May reduce propofol waste in TIVA without workflow disruption; leaves open need for prospective validation before practice change.
To evaluate whether estimating propofol requirement before surgery using a target-controlled infusion (TCI) model-based algorithm could reduce waste whilst maintaining workflow. Retrospective cohort study with in silico TCI-TIVA simulations using the Eleveld model at fixed effect-site targets (Cet 2.5–4.0 μg.ml −1 ) or a Cet corresponding to an estimated BIS of 45 (EC BIS45 ). Monte-Carlo simulation examined uncertainty in surgical duration estimates. University tertiary care provider. 229 adult patients undergoing general anesthesia with conventional propofol TIVA with manually adjusted infusion rate. Primary endpoint: predicted propofol amount for TCI and waste associated with three drawing-up strategies (50 ml vial only, 20 ml vial only, and vial combination based on estimated requirements). Secondary endpoint: relative number of syringe changes. Propofol requirements predicted using Cet 3.0 and EC BIS45 were similar to actual consumption. Algorithm-guided drawing-up produced significantly lower predicted waste than conventional TIVA practice ( p < 0.0001, CI = −61.0 to −27.0 mg/procedure for Cet 3.0; p = 0.001, CI = −60.0 to −26.7 mg/procedure for EC BIS45 ), comparable to the 20 ml vial-only strategy but requiring fewer syringe changes. Waste remained significantly lower despite surgical duration estimation errors up to 20% for Cet 3.0 ( p = 0.007) and 30% for EC BIS45 ( p = 0.01). Using the Eleveld TCI model to estimate pre-operative propofol requirements could significantly reduce waste and avoid excessive syringe changes, even when surgical duration is uncertain. • Pre-operative estimation of propofol requirements using the Eleveld TCI model matched actual consumption during TIVA. • Algorithm-guided preparation significantly reduced predicted waste without increasing the number of syringe changes. • Results remained robust despite uncertainty in estimated surgical duration, supporting its practical clinical applicability
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Windler et al. (2026) studied this question. Pre-operative estimation of propofol using the Eleveld TCI model reduced predicted waste by 27-61 mg per procedure (p<0.001) without increasing syringe changes.
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