الفهرس 
Liver AnatomyOnly 14 pages are availabe for public view
 |  | from | 128 |  |  |
| | | from | 128 | | |
Abstract
Introduction
Patients undergoing TIPS are medically complex as a result of
chronic liver disease causing multisystem physiological disruption. They
should receive multidisciplinary preoperative assessment and optimization
before undergoing the procedure Complexities of remote site, where the
care administration is in an unfamiliar environment with considering staff
and equipment availability. Sedation can be used to avoid the need for
general anesthesia, using combinations of short acting sedative agents. The
choice of drugs demand consideration of the physiological and
pharmacokinetic changes seen in chronic liver disease patients.
Target-controlled infusion (TCI), is an intravenous administration
system, which provides desired target plasma concentrations of therapeutic
agents and aims to maintain an appropriate depth of anesthesia. TCI has
become increasingly popular in clinical practice, due to its ability to
maintain more consistent plasma concentrations with fewer fluctuations.
Aim of the study
The purpose of this study was to compare the quality of sedation
during transjagular intra hepatic portosystemic shunt procedural with
propofol using target-controlled infusion versus manual infusion regarding
sedline score, hemodynamics, recovery pattern, and patient and radiologist
satisfaction.
Patients and methods:
This prospective randomized controlled study was performed on 78
ASA II patients enrolled for TIPS procedure. They received propofol
infusion for sedation using target-controlled infusion or manually. The target-controlled infusion group (n = 38) received propofol with the target
controlled infusion system (march‘s model) with the initial target plasma
concentration set at 4 μg ml−1in patients over 50 years old and 5 μg ml−1 in
patients under 50 years old with a bolus over 10 min. The manual infusion
group (n = 38) received propofol manually in a bolus of 1 mg kg−1 over 10
min, then infusion (170 µg/ kg/min) for 10 minutes and then (130
µg/kg/min) for other 10 minutes in maintenance doses of (100 µg/kg/min),
In both groups, the anesthesiologist adjusted to increase or decrease
the infusion rate according to sedline score and hemodynamics. We
recorded the amount of propofol, hemodynamics, sedline scores, patient‘s
and radiologist‘s satisfaction, recovery time, and side effects.