TCI: supplementation and drug interactions

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The pharmacokinetic and pharmacodynamic interactions between propofol and adjuvant agents have increasingly been recognised as clinically important and the improved knowledge of these interactions is being used to optimise the quality of intravenous anaesthesia. It is now known that propofol interferes with opioid metabolism, thereby increasing the plasma concentrations of the opioids, while opioids such as alfentanil increase propofol concentrations by reducing both the distribution and clearance of propofol. The pharmacokinetic interactions, however, are of relatively minor clinical importance compared with pharmacodynamic interactions. The pharmacodynamic interaction between propofol and other sedative agents, or one of the synthetic opioids, is synergistic. From the pharmacodynamic interaction data, optimal target propofol-opioid concentrations and optimal infusion regimens have been developed that ensure adequate anaesthesia in 50% and 95% of patients with the most rapid recovery possible. These optimal target propofol concentrations and infusion regimens are affected by the opioid with which propofol is combined, as well as the duration of infusion.

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