Titration of propofol for anesthetic induction and maintenance guided by the bispectral index:: Closed-loop versus manual control -: A prospective, randomized, multicenter study
Titration of propofol for anesthetic induction and maintenance guided by the bispectral index:: Closed-loop versus manual control -: A prospective, randomized, multicenter study
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DOI：
10.1097/00000542-200604000-00012
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发表时间：
2006-04-01
期刊：
影响因子：
8.8
通讯作者：
Fischler, M
中科院分区：
文献类型：
--
作者：
Liu, N;Chazot, T;Fischler, M
背景资料：本报告描述了一种基于由脑电双频指数（BIS）指导的比例微分算法的丙泊酚靶控输注的闭环滴定，允许诱导和维持全身麻醉，并将其与手动丙泊酚靶控输注进行比较。方法：在一项多中心研究中，将164例计划接受择期小手术或大手术的患者前瞻性随机分配至闭环研究中（n = 83）手动靶控组（n = 81）。目标是在诱导期间达到BIS目标值50，并在维持期间将其维持在40至60之间。两组患者均采用瑞芬太尼靶控输注方式，机械通气均不使用笑气。结果：闭环控制能够为所有患者提供麻醉诱导和维持。在诱导期间，闭环组的丙泊酚消耗量较低（1.4 +/- 0.5 vs. 1.8 +/- 0.6 mg/kg; P < 0.0001），但持续时间较长（320 +/- 125 vs. 271 +/- 120 s; P < 0.0002）。充分的麻醉维持（定义为BIS在40-60范围内）在闭环组中显著更高（89 +/- 9 vs. 70 21%; P < 0.0001），BIS小于40的发生率降低（8 +/- 8 vs. 26 22%; P < 0.0001）。闭环组从丙泊酚输注停止到拔管的时间较短（7 +/- 4 vs. 10 +/- 7 n-dn; P < 0.017）。不必要的躯体事件和血流动力学不稳定是similar.Conclusion：自动控制意识使用BIS是临床可行的，优于手动控制。
Background: This report describes a closed-loop titration of propofol target control infusion based on a proportional-differential algorithm guided by the Bispectral Index (BIS) allowing Induction and maintenance of general anesthesia and compares this to manual propofol target control infusion.Methods: One hundred sixty-four patients scheduled to undergo elective minor or major surgery were prospectively randomized in a multicenter study into the closed-loop (n = 83) or manual target control infusion group (n = 81). The goal was to reach a BIS target of 50 during induction and to maintain it between 40 and 60 during maintenance. For both groups, remifentanil target control infusion was adjusted manually, and ventilation was without nitrous oxide.Results: Closed-loop control was able to provide anesthesia induction and maintenance for all patients. During induction, propofol consumption was lower in the closed-loop group (1.4 +/- 0.5 vs. 1.8 +/- 0.6 mg/kg; P < 0.0001), but the duration was longer (320 +/- 125 vs. 271 +/- 120 s; P < 0.0002). Adequate anesthesia maintenance, defined as the BIS in the range of 40-60, was significantly higher in the closed-loop group (89 +/- 9 vs. 70 21%; P < 0.0001), with a decrease of the occurrence of BIS less than 40 (8 +/- 8 vs. 26 22%; P < 0.0001). Time from discontinuation of propofol infusion to tracheal extubation was shorter in the closed-loop group (7 +/- 4 vs. 10 +/- 7 n-dn; P < 0.017). Unwanted somatic events and hemodynamic instability were similar.Conclusion: Automatic control of consciousness using the BIS is clinically feasible and outperforms manual control.