Total intravenous anaesthesia in neonatal surgery: a case series using the Eleveld model

The practice of total intravenous anaesthesia (TIVA) target-controlled infusion of propofol (TCI-propofol) during neonatal surgery was limited by the lack of an appropriate pharmacokinetic-pharmacodynamic model and safety concerns. This is due to the physiological differences between the adult and neonate populations as well as inter-individual pharmacodynamic variation. Eleveld is the latest propofol pharmacokinetic model commercially available and the only model with the neonatal population in its algorithm design. We present a case series of neonates that underwent neonatal surgery under TIVA TCI-propofol utilising the Eleveld pharmacokinetic model. There was no observable clinically significant hypotension intraoperatively. Careful titration of TCI-propofol was necessary for timely emergence and maintaining haemodynamic stability. All neonates were extubated well postoperatively and recovered uneventfully. These demonstrated good and desirable anaesthetic effects using TCI-propofol without undesirable short-term side effects, especially clinically significant hypotension.