Target-controlled versus manual-controlled infusion of propofol: comparative hemodynamic stability during induction and recovery profiles in elderly patients undergoing sacral pressure ulcer flap surgerya non-randomized prospective observational study

Abstract

Background: This study compared the effects of Target-Controlled Infusion (TCI) versus Manually-Controlled
Infusion (MCI) of propofol on hemodynamic stability and recovery profiles in this vulnerable cohort, aiming to
establish the safer administration method.
Methodology: This was a single-center, non-randomized, prospective, observational study, involving 106 elderly
patients (≥ 65 years) (TCI n = 53, MCI n = 53). TCI used the Schnider model for propofol titration, while MCI
involved slow bolus injection. The primary endpoints were the incidence of post-induction hypotension (MAP
<65 mmHg or ≥30% reduction from baseline) and the need for vasopressor (phenylephrine) intervention.
Secondary outcomes included intra-induction hemodynamic trends and key recovery milestones (spontaneous
respiration, verbal command, LMA removal, and PACU discharge).
Results: Despite similar propofol induction doses, the TCI group showed a significantly longer induction time
(140.49 s vs. 52.81 s, 0.001). TCI provided superior hemodynamic stability, resulting in a substantially lower
incidence of post-induction hypotension (22.6% vs. 47.2%, p = 0.008) and a reduced need for phenylephrine
(9.4% vs. 34%, p = 0.002). Hemodynamic analysis showed that TCI mitigated both the depth of hypotension postinduction and the degree of reactive hypertension post-LMA insertion. The TCI group achieved all key recovery milestones significantly faster, including time to spontaneous respiration (8.15 min vs. 9.60 min, P < 0.001) and time to PACU discharge (29.21 min vs. 35.43 min, P < 0.001).
Conclusion: In high-risk elderly patients undergoing sacral flap surgery, propofol TCI may improve hemodynamic stability during induction and facilitate recovery compared to MCI. The controlled, gradual titration of TCI is highly effective in minimizing cardiovascular stress and could be considered a preferred technique for propofol administration in frail geriatric surgical populations.
Abbreviation: TCI: Target-Controlled Infusion; MCI: Manually Controlled Infusion; LMA: Laryngeal Mask Airway;
MAP: Mean Arterial Blood Pressure; PACU: Post Anaesthesia Care Unit
Keywords: Propofol; Target-Controlled Infusion; TCI; Manual Controlled Infusion; MCI; Elderly Patients;
Hypotension; Recovery Profile; Sacral Pressure Ulcer Flap Surgery
Citation: Vo HV, Nguyen QV, Vy AN. Target-controlled versus manual-controlled infusion of propofol:
comparative hemodynamic stability during induction and recovery profiles in elderly patients undergoing sacral
pressure ulcer flap surgery-a non-randomized prospective observational study. Anaesth. pain intensive care
2025;30(1):47-54. DOI: 10.35975/apic.v30i1.3101
Received: October 15, 2025; Revised: November 06, 2024; Accepted: November 06, 2025