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Feasibility of closed-loop titration of propofol guided by the Bispectral Index for general anaesthesia induction: a prospective randomized study

Published online by Cambridge University Press:  04 April 2006

N. Liu ,
T. Chazot ,
B. Trillat ,
R. Pirracchio ,
J.-D. Law-Koune ,
L. Barvais  and
M. Fischler
N. Liu
Affiliation:
Hôpital Foch, Department of Anaesthesiology, Suresnes, France
T. Chazot
Affiliation:
Hôpital Foch, Department of Anaesthesiology, Suresnes, France
B. Trillat
Affiliation:
Hôpital Foch, Informatics, Suresnes, France
R. Pirracchio
Affiliation:
Hôpital Foch, Department of Anaesthesiology, Suresnes, France
J.-D. Law-Koune
Affiliation:
Hôpital Foch, Department of Anaesthesiology, Suresnes, France
L. Barvais
Affiliation:
Hôpital Erasme ULB, Department of Anaesthesiology, Brussels, Belgium
M. Fischler
Affiliation:
Hôpital Foch, Department of Anaesthesiology, Suresnes, France
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Extract

Summary

Background: This study was designed to evaluate the feasibility of propofol infusion by a closed-loop system for the titration of anaesthetic induction guided by Bispectral Index. Methods: Forty patients were prospectively and randomly allocated into two groups: the target control infusion (TCI) group, where propofol titration was performed manually guided by the Bispectral Index using a commercial pharmacokinetic model (Diprifusor device) and the closed-loop group where titration was performed using a proportional differential algorithm. For both groups, the objective was to achieve a Bispectral Index of 50. Remifentanil TCI was infused at a target of 2 ng mL−1 and was maintained constant throughout the study. Feasibility of automatic induction was evaluated with performance error and haemodynamic data. Results: Bispectral Index overshoot (−9 ± 13% vs. −16 ± 20%, P = 0.035) and mean duration of induction (381 ± 106 s vs. 490 ± 131 s, P = 0.004) were lower in the closed-loop group than in the TCI group. Haemodynamic data were similar between groups with a similar use of ephedrine bolus. Conclusion: The system was able to allow induction clinically for all patients. Automated titration guided by Bispectral Index for propofol infusion was feasible without increase in haemodynamic adverse effects.

Keywords

ANAESTHESIA, INTRAVENOUS, depth of anaesthesia, Bispectral IndexANAESTHETICS INTRAVENOUS, propofolANALGESICS OPIOID, remifentanilDRUG DELIVERY SYSTEMS, closed-loop control
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 6 , June 2006 , pp. 465 - 469
Copyright
© 2006 European Society of Anaesthesiology

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References

Linkens DA, Hacisalihzade SS. Computer control systems and pharmacological drug administration: a survey. J Med Eng Technol 1990; 14: 41–54.Google Scholar
Kain ZN, Chan K-M, Katz JD et al. Anesthesiologists and acute perioperative stress: a cohort study. Anesth Analg 2002; 95: 177–183.Google Scholar
Mortier E, Struys M, De Smet T, Versichelen L, Rolly G. Closed-loop controlled administration of propofol using bispectral analysis. Anaesthesia 1998; 53: 749–754.Google Scholar
Morley A, Derrick J, Mainland P, Lee BB, Short TG. Closed loop control of anaesthesia: an assessment of the bispectral index as the target of control. Anesthesia 2000; 55: 953–959.Google Scholar
Struys MM, De Smet T, Versichelen LF et al. Comparison of closed-loop controlled administration of propofol using Bispectral Index as the controlled variable versus ‘standard practice’ controlled administration. Anesthesiology 2001; 95: 6–17.Google Scholar
Absalom AR, Sutcliffe N, Kenny GN. Closed-loop control of anesthesia using Bispectral index: performance assessment in patients undergoing major orthopedic surgery under combined general and regional anesthesia. Anesthesiology 2002; 96: 67–73.Google Scholar
Cantraine FR, Coussaert EJ. The first object oriented monitor for intravenous anesthesia. J Clin Monit Comput 2000; 16: 3–10.Google Scholar
Schnider TW, Minto CF, Shafer SL et al. The influence of age on propofol pharmacodynamics. Anesthesiology 1999; 90: 1502–1516.Google Scholar
Marsh B, White M, Morton N, Kenny G. Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth 1991; 67: 41–48.Google Scholar
Minto CF, Schnider TW, Egan TD et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology 1997; 86: 10–23.Google Scholar
Kenny G, Mantzaridis H. Closed-loop control of propofol anaesthesia. Br J Anaesth 1999; 83: 223–228.Google Scholar
Liu N, Chazot T, Huybrechts I et al. The influence of a muscle relaxant bolus on Bispectral and Datex-Ohmeda Entropy values during propofol-remifentanil induced loss of consciousness. Anesth Analg 2005; 101: 1713–1718.Google Scholar
Bauer M, Wilhelm W, Kraemer T et al. Impact of bispectral index monitoring on stress response and propofol consumption in patients undergoing coronary artery bypass surgery. Anesthesiology 2004; 101: 1096–1104.Google Scholar