European journal of anaesthesiology
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Propofol target-controlled infusion (TCI) in effect site mode has become popular since it became commercially available. ⋯ Pharmacokinetic analysis suggests that the performance of the Marsh model in effect site mode is poor in this broad patient population. The greatest bias demonstrated occurred in the early maintenance phase of anaesthesia. Of the covariates analysed, obesity contributed most significantly to an increased bias. Despite overall poor performance of the Marsh model, attending anaesthesiologists modified targeted propofol concentrations only 0.3 times per hour on average, using remifentanil dose modification nine times more frequently, with good surgical conditions in all patients.
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Ischaemia/reperfusion injury is a common problem in hepatic surgery. An appreciation of the role of sevoflurane dose in preconditioning and subsequent hepatoprotection against ischaemia/reperfusion injury would be useful. ⋯ Sevoflurane pretreatment exerts a protective effect on hepatic ischaemia/reperfusion injury but there is no significant dose-response relationship in the concentration range used. It is possible that a dose-response relationship might exist at lower concentrations.