Bristol Protocol - manual infusion scheme

[PAL]

Although I'm a British trained anaesthetist/anaesthesiologist, I haven't always worked in hospitals with TCI pumps available. In one such rural hospital, I had found myself using the so called "Roberts protocol" which is sometimes known as the "Bristol protocol".



The Roberts protocol was published in 1988. Full text available for free here:

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.1988.tb09061.x/abstract



It is dated as it uses 67% nitrous oxide and oral temazepam 20-30mg premed. I've used the manual protocol without nitrous and benzodiazepines to great effect. In fact one of my TIVA success stories was thanks to the Bristol protocol.



Patient: mid aged female for day case knee arthroscopy.

Past anaesthetic history: 12 previous anaesthetics (10 GA and 2 intrathecal blocks). All 12 times: severe PONV.

With my oxygen/air/propofol infusion/alfentanil bolus/paracetamol/NSAID/ondansetron/dexamethasone GA: patient was eating sandwiches in the recovery room. She couldn't believe it herself!



Give it a try. Your patients will thank you for it!

P-A

[mphelpsmd]

Hi P-A,



It's always gratifying to have patients that have night-and-day different experiences with volatile anesthetics and TIVA. The fact that she was able to a sandwich afterwords is testament to the wonderful attributes of TIVA.



And yes, the Bristol Technique/10-8-6 rule is how many people manage their propofol infusions to achieve plasma levels of approximately 3-4 mcg/mL. Or, as I call it, "TIVA For Americans". (It's sad that we have to say this, I know.)



Perhaps in the future this site can have a repository for useful articles, like the one you provided with the link to the article.



Michael