Paediatric applications of concentration-orientated anaesthesia

Although several hypnotic and opioid drugs are suitable for administration by continuous intravenous infusion, it is somewhat disquieting to realize just how little we know of their concentration–effect relationships during the early years of life; there remains great scope for clinical research in this area. Nevertheless, in the past few years we have gained sufficient information about the pharmacology of suitable drugs to formulate appropriate infusion dosage algorithms for children older than 2 years of age. Hence, target-controlled infusions (TCI) are becoming a practical proposition in paediatric anaesthesia. This review concentrates on the pharmacokinetics and pharmacodynamics of propofol, remifentanil and alfentanil when given by infusion to children. Evidence-based practical guidelines are given to enable manual infusion schemes to be utilized, although it is envisaged that commercially available TCI systems for young children will be available within a few years.