Automated titration of propofol and remifentanil decreases the anesthesiologist’s workload during vascular or thoracic surgery: a randomized prospective study
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Closed loop target-control infusion systems using a Bispectral (BIS) signal as an input (TCI Loop) can automatically maintain intravenous anesthesia in a BIS range of 40–60 %. Our purpose was to assess to what extent such a system could decrease anesthesia workload in comparison to the use of a stand alone TCI system manually adjusted to fit the same BIS range of 40–60 % (TCI Manual). Patients scheduled for elective vascular or thoracic surgery were randomized to the TCI Loop or TCI Manual method for administering propofol and remifentanil during both induction and maintenance of general anesthesia. Assessment of workload was performed by an independent observer who quoted each time the physician looked at the BIS monitor. The number of propofol and remifentanil target modifications, the percentage of time of adequate anesthesia i.e. BIS in the range 40–60 and hemodynamic data were recorded. Eighteen patients per group were enrolled. Characteristics, duration of surgery and propofol-remifentanil consumption were similar between groups. However, the percentage of time in the BIS range 40–60 % was higher in the TCI Loop versus TCI Manual groups (94 % ± 12 vs. 74 % ± 19, p < 0.001). Mean arterial pressure was lower with TCI Manual (78 ± 6 vs. 88 ± 13 mmHg, p < 0.001). The number of times the anesthesiologist watched the controller or BIS monitor (p < 0.05) and the number of manual adjustments (p < 0.001) performed in each group was lower with TCI Loop group during induction and maintenance of anesthesia. An automated controller strikingly frees the anesthesiologist from manual intervention to adjust drug delivery.
KeywordsDrug delivery systems Pharmacokinetics Anesthesia Intravenous Ergonomics Intravenous drug delivery systems
This work has been sponsored by the CHU d’Angers. The authors have no financial relationship with this organisation. Ngai Liu and Thierry Chazot have patented in France the algorithm of the closed loop system used in this study (# BFF08P669, Institut National de la Propriété Industrielle). None of the authors has a personal financial interest in this research.
Conflict of interest
The authors declare they have no conflict of interest.
- 4.Struys MM, De Smet T, Versichelen LF, Van De Velde S, Van den Broecke R, Mortier EP. 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.PubMedCrossRefGoogle Scholar
- 5.Liu N, Chazot T, Genty A, Landais A, Restoux A, McGee K, Laloe PA, Trillat B, Barvais L, Fischler M. Titration of propofol for anesthetic induction and maintenance guided by the bispectral index: closed-loop versus manual control: a prospective, randomized, multicenter study. Anesthesiology. 2006;104:686–95.PubMedCrossRefGoogle Scholar
- 11.Minto CF, Schnider TW, Egan TD, Youngs E, Lemmens HJ, Gambus PL, Billard V, Hoke JF, Moore KH, Hermann DJ, Muir KT, Mandema JW, Shafer SL. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil I. Model development. Anesthesiology. 1997;86:10–23.PubMedCrossRefGoogle Scholar
- 13.Jastremski M, Jastremski C, Shepherd M, Friedman V, Porembka D, Smith R, Gonzales E, Swedlow D, Belzberg H, Crass R, et al. A model for technology assessment as applied to closed loop infusion systems. Technology assessment task force of the society of critical care medicine. Crit Care Med. 1995;23:1745–55.PubMedCrossRefGoogle Scholar
- 17.Le Guen M, Liu N, Bourgeois E, Chazot T, Sessler DI, Rouby JJ, Fischler M: Automated sedation outperforms manual administration of propofol and remifentanil in critically ill patients with deep sedation: a randomized phase II trial. Intensive Care Med 2013;39(3):454–62.Google Scholar