From the Research
To use the Eleveld model for target-controlled infusion (TCI) of propofol, first select it on your TCI pump if available, as it's designed to accurately predict propofol pharmacokinetics across diverse patient populations, although its predictive performance should be interpreted with caution due to significant within-subject and between-subject variation 1. When using the Eleveld model, enter the patient's demographics including age, weight, height, and sex, as these parameters significantly influence drug distribution and clearance.
- Set your target effect-site concentration typically between 2-6 mcg/ml for sedation and 4-8 mcg/ml for general anesthesia, adjusting based on clinical response.
- The Eleveld model accounts for age-related changes in pharmacokinetics and is particularly valuable for pediatric and elderly patients, as well as obese individuals, where traditional models may be less accurate.
- During maintenance, titrate the target concentration based on clinical signs, hemodynamic parameters, and depth of anesthesia monitoring, considering the model's limitations in predicting bispectral index (BIS) values 1. Some studies have adapted the Eleveld model for specific uses, such as high-dose propofol treatments for depression, showing improved predictive performance for burst-suppression ratio (BSR) endpoints 2. However, the most recent and highest quality study on the Eleveld model's performance in general anesthesia highlights its acceptable predictive precision but also notes significant variability 1. The model's strength lies in its development from a large, diverse dataset that better accounts for inter-individual variability in propofol handling compared to older models like Marsh or Schnider, as demonstrated in prospective clinical validation studies 3. Remember that the Eleveld model provides estimates that should guide rather than replace clinical judgment, and always monitor the patient's vital signs, level of consciousness, and respiratory status regardless of the model used. It is also important to consider that some evidence may not be directly related to the use of the Eleveld model, such as studies on chronic myeloid leukemia or migraine epidemiology 4, 5, and should not influence the decision on how to use the model.