Target controlled vs. manually controlled infusion of propofol for sedation during transjugular intrahepatic portosystemic shunt procedure: a randomized controlled trial

Background & objective: Transjugular intrahepatic portosystemic shunt (TIPS) is used to form a tract between the portal and the hepatic veins, with a metallic stent bridged through the hepatic parenchyma for patients who have chronic liver disease causing multisystem physiological disruption. The purpose of this study was to compare the quality of sedation in the radiology suit during TIPS procedure with propofol using target-controlled infusion (TCI) versus manual infusion. Methodology: This prospective study enrolled 78 ASA II patients, scheduled for TIPS procedure, who were randomly allocated into two equal groups; TCI group to have sedation with propofol guided with TCI system, and MCI group (manual infusion group) received propofol manually. We aimed primarily to study the effectiveness of TCI in sedation for TIPS procedure regarding SedLine levels and sedation-related complications, while the secondary outcomes were to evaluate the amount of total propofol consumption, the recovery time, with recording the patient and interventional radiologist satisfaction. Results: There were statistically highly significant higher SedLine readings in the MCI group at times of venography and balloon dilation compared to TCI group respectively (P < 0.001). The TCI group showed more stable hemodynamics when compared to MCI group. While there was highly significant lower result in the TCI than MCI group regarding propofol dose (589.6 ± 174.9 vs. 711.6 ± 53.3 mg) and Recovery time (12.9 ± 3.9 vs. 18.3 ± 4.5 min; P < 0.0010) respectively. Also, the TCI group showed more patient and radiologist satisfaction scores. Conclusion: Target-controlled infusion achieved more effective sedation for transjugular intrahepatic portosystemic shunt procedure, with less propofol consumption, and less sedation related complications. Target-controlled infusion had better patient and interventional radiologist satisfaction when compared to manually controlled infusion. Key words: Chronic Liver Disease; Propofol; Target Control Infusion; Transjugular Intrahepatic Portosystemic Shunt Procedure Citation: Elshafie MA, Salem MA, Ghoniem AM, Abdelrahman AI. Target controlled vs. manually controlled infusion of propofol for sedation during transjugular intrahepatic portosystemic shunt procedure: a randomized controlled trial. Anaesth. pain intensive care 2025;29(3):403-410. DOI: 10.35975/apic.v29i3.2754 Received: January 04, 2025; Revised: March 14, 2025; Accepted: March 29, 2025