Regarding a propofol ampoule:
It contains egg products so shouldn’t be given to patients with an egg allergy T/F
The contents are white because it contains soya bean oil$ T/F
It costs more than an ampoule of thiopentone T/F
It contains antimicrobial preservative T/F
If you drank a 100ml ampoule it would make you quite sleepy* T/F
$ Ask yourself what colour most oils are and what colour mayonnaise is and why they aren’t the same…
*In the trial of Michael Jackson’s cardiologist come ‘anesthesiologist’, Conrad Murray, an expert witness for the defence suggested that Jackson swigged a whole lot of propofol. This hypothesis was strongly refuted by the expert witness for the prosecution who happened to be none other than Steve Shafer. Who was correct?
Many of us use TCI on a daily basis. Indeed some people use it almost exclusively. Fewer appreciate the remarkably small data set that the algorithms were created from. Even fewer understand the limitations of the algorithms. If you want to find the answers to the statements below can I suggest you look at the chapter “Everything you should know about Propofol TCI” in the book The First Year. It can be freely downloaded from the College Library: click on Library Guides> Medical Education> Featured Resources and scroll to the bottom. The pdf is waiting for you. The cover is reproduced above. The TCI pump algorithms are poorly treated in the texts.
Q. A TCI using the Marsh algorithm will give the same dose of propofol to an eighty year old and a twenty year old patient of the same weight. TRUE/ FALSE
Q. TCI can be used for morbidly obese patients. TRUE/ FALSE
Q. The Minto algorithm for Remifentanil was devised by an Australian anaesthetist. TRUE/ FALSE
Q. Plasma or effect site TCI can be used effectively for the Schnider algorithm.
Q. The James equations are used to calculate LBM in the Minto and Schnider algorithms. TRUE/ FALSE
Propofol and remifentanil target controlled infusions are often given together as a total intravenous anaesthesia technique. Discuss pharmacological reasons why this is a useful combination.
BT_GS 1.59 BT_GS 1.53 BT_GS 1.41
A practical pharmacology question on a common drug combination. Before setting out to write a model answer try asking yourself first what are the clinical reasons you use this combination.
There are significant pharmacokinetic interactions between these drugs TRUE/FALSE
There are significant pharmacodynamic interactions between these drugs TRUE/FALSE
Both drugs have a rapid offset TRUE/FALSE
Adding remifentanil to propofol can lead to more stable haemodynamics TRUE/FALSE
Can be used in patients susceptible to malignant hyperthermia TRUE/FALSE
BT_GS 1.59 Describe the pharmacological principles of and sources of error with target controlled infusion
I am sure you have all looked at this screen. Here are some questions to test your knowledge of these models.
TRUE/FALSE Inaccurate drug delivery from the infusion pump contributes to 55% of the overall inaccuracy of a TCI infusion
TRUE/FALSE With most modern TCI algorithms actual plasma concentrations are within 20-30% of predicted concentrations 95% of the time
TRUE/FALSE The Marsh model uses age and weight to calculate the compartment size
TRUE/FALSE The Schnider model may calculate a negative lean body mass in very obese patients
TRUE/FALSE The most clinically reliable method is to target the effect site concentration observed at loss of consciousness.