Eleveld TCI Protocol

• Eleveld is a new propofol pharmacokinetic-pharmacodynamic (PKePD) model, developed using the bispectral index (BIS) as the targeted endpoint. 
• As the algorithm does not use LBM, then there are no limits on weight, which are applied by the LBM calculation, for example:

    Schnider, Male, 50 years, 170cm: Max weight 121 Kg 

Eleveld, Male, 50 years, 170cm: Max weight 160 Kg

• This removes the need to ‘stretch’ patients to make them ‘fit’ LBM calculations.

1. Eleveld, D. J., Colin, P., Absalom, A. R., & Struys, M. M. R. F. (2018). Pharmacokinetic–pharmacodynamic model for propofol for broad application in anaesthesia and sedation. British journal of anaesthesia, 120(5), 942-959.

 Figure: Relationships between effect-site concentration and predicted BIS, and the relationship between age and effect-site concentration for 50% and 10% drug effect for the final PKePD model. BIS, bispectral index. 

• The weight range for Eleveld covers Neonatal to Adult applications in a single protocol (3kg to 160kg).
• Eleveld incorporates the ‘enhanced’ effect of delivering Propofol with an Opioid and adjusts for this. Two protocols are typically created on the pump, one for Anaesthesia (Propofol plus Opioid) and one for Sedation (Propofol only).
• The induction bolus on Eleveld is higher than on Schnider/Marsh, so the initial effect-site. target should be lower. The suggestion is to set an initial target to the Ce50 value from the right-hand graph below, and later titrate to effect. As the induction bolus is larger, care should be taken with fragile patients. 

1. Eleveld, D. J., Colin, P., Absalom, A. R., & Struys, M. M. R. F. (2018). Pharmacokinetic–pharmacodynamic model for propofol for broad application in anaesthesia and sedation. British journal of anaesthesia, 120(5), 942-959.