Comparison of Target-Controlled Infusion vs. Manual Infusion of Propofol on Postoperative Recovery in Gynecological Endoscopic Procedures: An Open-Label Randomized Controlled Trial

Abstract

Background: TIVA with propofol using a manually controlled infusion technique may cause delayed recovery or awareness due to overdosing or underdosing of an anaesthetic. However, TCI can optimally deliver anaesthetic by adjusting the infusion rates based on the pharmacokinetic profile of propofol. This study aimed to compare the recovery time after termination of propofol infusion in TCI with that of the manual infusion technique in patients undergoing gynaecological endoscopic procedures.

Methods: In this randomized trial, 100 female patients (18–65 years, American Society of Anesthesiologists (ASA - I/II) undergoing gynaecological endoscopic procedures were assigned to Manual or TCI propofol infusion. The Manual group (n=50) received propofol using the Bristol formula, while the TCI group (n=50) received a pump targeting 4 mcg/ml (Marsh model). Recovery time, total propofol dose, and post-induction MAP changes were measured with target BIS value of 40–60.

Results: The demographic data were comparable between the groups. The recovery time was faster with the TCI group (478.4±52.76 seconds) than the manual group (505.8±65.15 seconds) (p=0.0229). No significant difference was observed in total propofol consumption (p=0.199), with mean values of 14.47±1.24 mg/kg/hr in Group T and 14.12±1.46 mg/kg/hr in Group M. Patients in manual infusion group had better haemodynamic parameters than TCI group with less fall in mean arterial pressure post-induction. A significant difference was found in the percentage change in MAP (p=0.0003), with Group T showing a mean change of 9.18±2.6% and Group M 11.2±2.8%.

Conclusion: TCI offers significantly shorter recovery time and better post-induction haemodynamic parameters than manual propofol infusion in patients undergoing gynaecological endoscopic procedures.