Automated titration of propofol and remifentanil decreases the anesthesiologist's workload during vascular or thoracic surgery: a randomized prospective study
Automated titration of propofol and remifentanil decreases the anesthesiologist's workload during vascular or thoracic surgery: a randomized prospective study
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DOI：
10.1007/s10877-013-9453-6
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发表时间：
2014-02-01
影响因子：
2.2
通讯作者：
Beydon, Laurent
中科院分区：
文献类型：
--
作者：
Dussaussoy, Corinne;Peres, Marine;Beydon, Laurent
使用双频谱（BIS）信号作为输入（TCI Loop）的闭环目标控制输注系统可以自动将静脉麻醉维持在BIS 40- 60%的范围内。我们的目的是评估与使用手动调整以适应相同BIS范围40- 60%（TCI手动）的独立TCI系统相比，该系统可以在多大程度上减少麻醉工作量。择期血管或胸外科手术的患者被随机分配至TCI Loop或TCI Manual方法，在全麻诱导和维持期间给予丙泊酚和瑞芬太尼。由独立观察员进行工作负荷评估，每次医生查看BIS监测器时，观察员都会引用。记录丙泊酚和瑞芬太尼靶点调整次数、充分麻醉时间百分比（BIS在40-60范围内）和血流动力学数据。每组入组18例患者。两组的特征、手术持续时间和丙泊酚-瑞芬太尼消耗量相似。然而，TCI循环组BIS范围40- 60%的时间百分比高于TCI手动组（94%+/- 12 vs. 74%+/- 19，p < 0.001）。TCI手动组的平均动脉压较低（78 +/- 6 vs. 88 +/- 13 mmHg，p < 0.001）。在麻醉诱导和维持期间，麻醉师观察控制器或BIS监测器的次数（p < 0.05）和手动调整的次数（p < 0.001）均低于TCI Loop组。自动控制器显著地将麻醉师从手动干预中解放出来，以调整药物输送。
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.