{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T21:51:01Z","timestamp":1777758661027,"version":"3.51.4"},"reference-count":80,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Target-controlled infusion (TCI) enables the precise delivery of intravenous anesthetics based on pharmacokinetic\u2013pharmacodynamic (PK\u2013PD) models and represents a key component of total intravenous anesthesia (TIVA). However, its use in obstetric anesthesia remains limited, as current TCI algorithms are derived from non-pregnant populations and do not account for pregnancy-related physiological changes or maternal\u2013fetal drug distribution. This narrative review examines the clinical application of TIVA-TCI in caesarean delivery under general anesthesia, summarizing evidence from recent observational studies and national audits, which suggest feasibility but limited adoption in routine obstetric practice. Pregnancy induces significant alterations in drug distribution, protein binding, metabolism, and clearance, which may affect anesthetic pharmacokinetics and fetal exposure. Physiologically based pharmacokinetic (PBPK) modeling is explored as a complementary approach that may improve understanding of maternal\u2013fetal drug disposition by integrating physiological and drug-specific parameters. Although promising, these model-based strategies require further validation before clinical implementation. Overall, current evidence supports the cautious use of TIVA-TCI in selected obstetric settings while highlighting the need for pregnancy-specific pharmacokinetic models and prospective clinical studies.<\/jats:p>","DOI":"10.3390\/life16050739","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T12:31:56Z","timestamp":1777465916000},"page":"739","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Target-Controlled\u00a0 Infusion for Caesarean Delivery Under General Anesthesia: From Conventional Pharmacokinetic Models to Physiologically Based Pharmacokinetic Modeling"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1019-9118","authenticated-orcid":false,"given":"Matild","family":"Keresztes","sequence":"first","affiliation":[{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mures, 540139 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonard","family":"Azamfirei","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540139 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emoke","family":"Almasy","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540139 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9359-6058","authenticated-orcid":false,"given":"Janos","family":"Szederjesi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540139 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref_1","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. 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