{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:36:49Z","timestamp":1791815809908,"version":"4.3.4"},"reference-count":23,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: General anesthesia is occasionally required for cesarean delivery (CD). Propofol target-controlled infusion (TCI) enables dosing based on pharmacokinetic modeling. During the transition from induction to maintenance, infusion pauses. This simulation study assessed propofol from induction to delivery and the proportion of deliveries estimated during this pause. Methods: Surgical data from women undergoing CD were compiled, and the demographics were entered into a TCI pump using the Schnider model. Effect-site targets (6 and 8 mcg\/mL) were simulated for induction, followed by 2.5 mcg\/mL for maintenance. Outcomes were estimated propofol dose from induction to delivery and timing of delivery relative to infusion pause. Results: Among 50 women, the estimated mean propofol dose from induction to delivery was 19 \u00b1 22 mg (0.2 \u00b1 0.3 mg\/kg) at 6 mcg\/mL and 13 \u00b1 17 mg (0.2 \u00b1 0.2 mg\/kg) at 8 mcg\/mL. Delivery occurred during the infusion pause in 40% and 50% of cases, and it was more often in emergency than elective procedures. Emergency status, but not age or body mass index, predicted delivery during the pause. Conclusions: Standardized TCI with reduced effect-site targets for maintenance resulted in modest propofol administration between induction and delivery. These findings require confirmation in clinical studies, where dosing should be guided by depth-of-anesthesia monitoring.<\/jats:p>","DOI":"10.3390\/jcm14207234","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T11:57:42Z","timestamp":1760529462000},"page":"7234","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Simulation of Propofol Target-Controlled Infusion up to Time of Delivery in Cesarean Section: A Bench Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Ilja","family":"Osthoff","sequence":"first","affiliation":[{"name":"Institute for Anesthesia, Spital Thurgau, 8500 Frauenfeld, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Soare","sequence":"additional","affiliation":[{"name":"Institute for Anesthesia, Spital Thurgau, 8500 Frauenfeld, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Barana","sequence":"additional","affiliation":[{"name":"Institute for Anesthesia, Spital Thurgau, 8500 Frauenfeld, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wieland","family":"Sell","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Spital Thurgau Frauenfeld, 8500 Frauenfeld, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JoEllen","family":"Welter","sequence":"additional","affiliation":[{"name":"Institute for Anesthesia, Spital Thurgau, 8500 Frauenfeld, Switzerland"},{"name":"Department of Obstetrics and Gynecology, Spital Thurgau Frauenfeld, 8500 Frauenfeld, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1456-6457","authenticated-orcid":false,"given":"Alexander","family":"Dullenkopf","sequence":"additional","affiliation":[{"name":"Institute for Anesthesia, Spital Thurgau, 8500 Frauenfeld, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.bjae.2020.03.003","article-title":"General Anaesthesia in Obstetrics","volume":"20","author":"Delgado","year":"2020","journal-title":"BJA Educ."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Gwanzura, C., Gavi, S., Mangiza, M., Moyo, F.V., Lohman, M.C., Nhemachena, T., and Chipato, T. (2023). Effect of Anesthesia Administration Method on Apgar Scores of Infants Born to Women Undergoing Elective Cesarean Section. BMC Anesthesiol., 23.","DOI":"10.1186\/s12871-023-02098-w"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.bpa.2024.11.003","article-title":"Cesarean Delivery: Clinical Updates","volume":"38","author":"Lee","year":"2024","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_4","first-page":"CD004350","article-title":"Regional Versus General Anaesthesia for Caesarean Section","volume":"10","author":"Afolabi","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"256","DOI":"10.17085\/apm.22196","article-title":"General Anesthesia for Cesarean Section: Are We Doing It Well?","volume":"17","author":"Choi","year":"2022","journal-title":"Anesth. Pain Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"358","DOI":"10.12968\/hmed.2017.78.6.358","article-title":"General Anaesthesia for Caesarean Section: Is the End in Sight for Thiopental?","volume":"78","author":"Desai","year":"2017","journal-title":"Br. J. Hosp. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ijoa.2018.05.008","article-title":"A Survey of Practice of Rapid Sequence Induction for Caesarean Section in England","volume":"36","author":"Desai","year":"2018","journal-title":"Int. J. Obstet. Anesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1097\/ACO.0000000000000185","article-title":"General Anesthesia for Caesarean Section","volume":"28","author":"Devroe","year":"2015","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_9","first-page":"673","article-title":"Thiopental Versus Propofol on the Outcome of the Newborn After Caesarean Section: Can Urgency Grade Affect the Impact?","volume":"38","author":"Karim","year":"2019","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Hedawy, S., Labeeb, E., Aldalahmeh, S., Elswaf, A., AlManaseer, M., Shehab, M.A., and Menshawy, A. (J. Anesth., 2025). Hypnotics as Induction Agents for General Anesthesia in Cesarean Section Patients: Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials, J. Anesth., online ahead of print.","DOI":"10.1007\/s00540-025-03524-8"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/S0140-6736(05)60265-6","article-title":"Placental Propofol Transfer and Fetal Sedation During Maternal General Anaesthesia in Early Pregnancy","volume":"352","author":"Jauniaux","year":"1998","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1111\/anae.15250","article-title":"General Anaesthetic and Airway Management Practice for Obstetric Surgery in England: A Prospective, Multicentre Observational Study","volume":"76","author":"Odor","year":"2021","journal-title":"Anaesthesia"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s00540-020-02866-9","article-title":"Effects of Anesthetic Agents on Contractions of the Pregnant Rat Myometrium in Vivo and in Vitro","volume":"35","author":"Kimizuka","year":"2021","journal-title":"J. Anesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"103548","DOI":"10.1016\/j.ijoa.2022.103548","article-title":"The Role of Total Intravenous Anaesthesia for Caesarean Delivery","volume":"51","author":"Metodiev","year":"2022","journal-title":"Int. J. Obstet. Anesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"371","DOI":"10.4103\/joacp.joacp_64_23","article-title":"Target-Controlled Infusion\u2014Past, Present, and Future","volume":"40","author":"Bidkar","year":"2024","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1213\/ANE.0000000000001005","article-title":"The Safety of Target-Controlled Infusions","volume":"122","author":"Schnider","year":"2016","journal-title":"Anesth. Analg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/anae.14428","article-title":"Guidelines for the Safe Practice of Total Intravenous Anaesthesia (Tiva): Joint Guidelines from the Association of Anaesthetists and the Society for Intravenous Anaesthesia","volume":"74","author":"Nimmo","year":"2019","journal-title":"Anaesthesia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1111\/j.1365-2044.2007.05419_1.x","article-title":"Pharmacokinetic Models of Propofol for Tci","volume":"63","author":"Schnider","year":"2008","journal-title":"Anaesthesia"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.bpa.2022.04.007","article-title":"Neuraxial and General Anaesthesia for Caesarean Section","volume":"36","author":"Watson","year":"2022","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_20","first-page":"1825","article-title":"Effects of Sevoflurane or Propofol Combined with Remifentanil Anesthesia on Clinical Efficacy and Stress Response in Pregnant Women with Pregnancy-Induced Hypertension","volume":"22","author":"Ren","year":"2018","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1007\/s00540-015-2099-4","article-title":"Rethinking General Anesthesia for Cesarean Section","volume":"30","author":"Sumikura","year":"2016","journal-title":"J. Anesth."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1093\/bja\/aer108","article-title":"Optimizing Intravenous Drug Administration by Applying Pharmacokinetic\/Pharmacodynamic Concepts","volume":"107","author":"Struys","year":"2011","journal-title":"Br. J. Anaesth."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1093\/bja\/aen144","article-title":"Awareness with Recall During General Anaesthesia: A Prospective Observational Evaluation of 4001 Patients","volume":"101","author":"Errando","year":"2008","journal-title":"Br. J. Anaesth."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7234\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T12:21:38Z","timestamp":1760530898000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7234"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":23,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14207234"],"URL":"https:\/\/doi.org\/10.3390\/jcm14207234","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]}}}