The influence of moderate or deep neuromuscular block status on anesthetic depth monitoring system during total intravenous anesthesia using propofol and remifentanil: A randomized trial

The neuromuscular block state may affect the electroencephalogram-derived index representing the anesthetic depth. We applied an Anesthetic Depth Monitoring for Sedation (ADMS) to patients undergoing laparoscopic cholecystectomy under total intravenous anesthesia, and evaluated the requirement of propofol according to the different neuromuscular block state. Adult patients scheduled to undergo laparoscopic cholecystectomy were enrolled and randomly assigned to either the moderate (MB) or deep neuromuscular block (DB) group. The UniCon sensor of ADMS was applied to monitor anesthetic depth and the unicon value was maintained between 40 and 50 during the operation. According to the group assignment, intraoperative rocuronium was administered to maintain proper neuromuscular block state, moderate or deep block state. The unicon value, electromyography (EMG) index, and total dose of propofol and rocuronium were analyzed. At similar anesthetic depth, less propofol was used in the DB group compared to the MB group (6.19 ± 1.36 in the MB mg/kg/h group vs 4.93 ± 3.02 mg/kg/h in the DM group, p = 0.042). As expected, more rocuronium were used in the DB group than in the MB group (0.8 ± 0.2 mg/kg in the MB group vs 1.2 ± 0.2 mg/kg in the DB group, p = 0.023) and the EMG indices were lower in the DB group than in the MB group, at several time points as follows: at starting operation ( p < 0.001); at 15 ( p = 0.019), 45 ( p = 0.011), and 60 min ( p < 0.001) after the initiation of the operation; at the end of operation ( p = 0.003); and at 5 min after the administration of sugammadex ( p < 0.001). At similar anesthetic depth, patients under the deep neuromuscular block state required less propofol with lower intraoperative EMG indices compared to those under the moderate neuromuscular block state during general anesthesia.

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Total Intravenous Anesthesia In Laparoscopic Cholecystectomy: Comparison Of Butorphanol And Fentanyl

The Internet Journal of Anesthesiology ◽

10.5580/1dd9 ◽

2007 ◽

Vol 14 (1) ◽

Cited By ~ 2

Keyword(s):

Laparoscopic Cholecystectomy ◽

Total Intravenous Anesthesia ◽

Intravenous Anesthesia

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Retrospective analysis of cases of intraoperative awareness in a large multi-hospital health system reported in the early postoperative period

10.21203/rs.2.12303/v4 ◽

2020 ◽

Author(s):

Amanda S. Deis ◽

Michael P. Schnetz ◽

James W. Ibinson ◽

Keith M Vogt

Keyword(s):

Adverse Event ◽

General Anesthesia ◽

Total Intravenous Anesthesia ◽

General Anesthetics ◽

Eeg Monitoring ◽

Event Data ◽

Intravenous Anesthesia ◽

Intraoperative Awareness ◽

Anesthesia Providers ◽

Adverse Event Data

Abstract Background : Awareness with recall under general anesthesia remains a rare but important issue that warrants further study. Methods : We present a series of seven cases of awareness that were identified from provider-reported adverse event data from the electronic anesthesia records of 647,000 general anesthetics. Results : The low number of identified cases suggests an under-reporting bias. Themes that emerge from this small series can serve as important reminders to anesthesia providers to ensure delivery of an adequate anesthetic for each patient. Commonalities between a majority of our identified anesthetic awareness cases include: obesity, use of total intravenous anesthesia, use of neuromuscular blockade, and either a lack of processed electroencephalogram (EEG) monitoring or documented high depth of consciousness index values. An interesting phenomenon was observed in one case, where adequately-dosed anesthesia was delivered without technical issue, processed EEG monitoring was employed, and the index value suggested an adequate depth of consciousness throughout the case. Conclusions : Provider-reported adverse event data in the immediate post-operative period are likely insensitive for detecting cases of intraoperative awareness. Though causation cannot firmly be established from our data, themes identified in this series of cases of awareness with recall under general anesthesia provide important reminders for anesthesia providers to maintain vigilance in monitoring depth and dose of anesthesia, particularly with total intravenous anesthesia.

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Effects of circadian rhythm on Narcotrend index and target-controlled infusion concentration of propofol anesthesia

BMC Anesthesiology ◽

10.1186/s12871-021-01445-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiang-hua Shen ◽

Min Ye ◽

Qian Chen ◽

Yan Chen ◽

Hai-lin Zhao ◽

...

Keyword(s):

Circadian Rhythms ◽

General Anesthesia ◽

Closed Loop ◽

Depth Of Anesthesia ◽

Drug Infusion ◽

Anesthetic Depth ◽

Time Points ◽

Target Controlled Infusion ◽

Medical University ◽

Narcotrend Index

Abstract Background The effects of circadian rhythms on drug metabolism and efficacy are being increasingly recognized. However, the extent to which they affect general anesthesia remains unclear. This study aims to investigate the effects of circadian rhythms on anesthetic depth and the concentrations of propofol target-controlled infusion (TCI). Methods Sixty patients undergoing laparoscopic surgeries were sequentially assigned to four groups. Group ND (n = 15): Propofol TCI with Narcotrend monitor during the day (8:00–18:00), Group NN (n = 15): Propofol TCI with Narcotrend monitor during the night (22:00–5:00), Group CLTD (n = 15): Propofol closed-loop TCI guided by bispectral index (BIS) during the day (8:00–18:00), Group CLTN (n = 15): Propofol closed-loop TCI guided by BIS during the night (22:00–5:00). The Narcotrend index, mean arterial pressure (MAP) and heart rate (HR) were compared between group ND and NN at 7 time points, from 5 min before induction to the end of operation. The propofol TCI concentrations, MAP and HR were compared between group CLTD and CLTN at 7 time points, from 5 min after induction to the end of operation. Results The Narcotrend index, MAP, and HR in group NN were lower than those in group ND from the beginning of mechanical ventilation to the end of operation (p < 0.05). The propofol TCI concentrations in group CLTN were lower than those in group CLTD from the beginning of operation to the end of operation (p < 0.05). Conclusion Circadian rhythms have a significant effect on the depth of anesthesia and drug infusion concentrations during propofol TCI. When using general anesthesia during night surgery, the propofol infusion concentration should be appropriately reduced compared to surgery during the day. Trial registration The present study was registered on the ClinicalTrials.gov website (NCT02440269) and approved by the Medical Ethics Committee of Southwest Hospital of Third Military Medical University (ethics lot number: 2016 Research No. 93). All patients provided informed written consent to participate in the study.

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Retrospective analysis of cases of intraoperative awareness in a large multi-hospital health system reported in the early postoperative period

10.21203/rs.2.12303/v5 ◽

2020 ◽

Author(s):

Amanda S. Deis ◽

Michael P. Schnetz ◽

James W. Ibinson ◽

Keith M Vogt

Keyword(s):

Adverse Event ◽

General Anesthesia ◽

Total Intravenous Anesthesia ◽

General Anesthetics ◽

Eeg Monitoring ◽

Event Data ◽

Intravenous Anesthesia ◽

Intraoperative Awareness ◽

Anesthesia Providers ◽

Adverse Event Data

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Neuromuscular block monitoring by smartphone application (i-TOF© system): an observational pilot study

npj Digital Medicine ◽

10.1038/s41746-020-00344-w ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Lorenzo Schiavoni ◽

Giuseppe Pascarella ◽

Stefania Grande ◽

Felice Eugenio Agrò

Keyword(s):

Pilot Study ◽

General Anesthesia ◽

Neuromuscular Block ◽

Good Clinical Practice ◽

Smartphone Application ◽

Comparable Efficacy ◽

Time Intervals ◽

Mean Values ◽

Residual Curarization ◽

Deep Neuromuscular Block

Abstract Neuromuscular block monitoring is recommended by international guidelines to improve myorelaxation during surgery and reduce the risk of postoperative residual curarization. We conducted a pilot study to verify the efficacy of i-TOF, a wireless neuromuscular monitoring device connectable to a smartphone, comparing it with TOF WATCH SX. We enrolled 53 patients who underwent general anesthesia. For each patient, we recorded by both devices, in different time intervals, train-of-four (TOF) count/ratio after induction to general anesthesia (TI0–TI3) and during recovery (TR0–TR3). Moreover, post-tetanic count (PTC) was evaluated during deep neuromuscular block (TP0–TP2). We noticed no significant differences between the devices in recorded mean values of TOF ratio, TOF count, and PTC analyzed at time intervals for every phase of general anesthesia, although the i-TOF tends to an underestimation compared to TOF WATCH SX. For each patient, data sessions were successfully recorded by a smartphone. This aspect could be relevant for clinicians in order to have a stored proof of good clinical practice to be added on anesthesiologist records. By our results, i-TOF demonstrates a comparable efficacy to TOF WATCH SX, suggesting that it could be a proven alternative to standard devices for neuromuscular block monitoring. Further studies are needed to confirm our findings.

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Technical and clinical evaluation of a closed loop TIVA system with SEDLineTM spectral density monitoring: Multicentric prospective cohort study

Perioperative Medicine ◽

10.1186/s13741-019-0130-2 ◽

2020 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Claudia Castellanos Peñaranda ◽

Fabián D. Casas Arroyave ◽

Francisco J. Gómez ◽

Paola A. Pinzón Corredor ◽

Juan M. Fernández ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort ◽

Closed Loop ◽

Clinical Performance ◽

Total Intravenous Anesthesia ◽

Closed Loop System ◽

Intravenous Anesthesia ◽

Anesthetic Depth ◽

Maintenance Time ◽

Performance Error

Abstract Introduction Closed loop total intravenous anesthesia is a technique in which the patient’s hemodynamic and anesthetic depth variables are monitored, and based on this information, a computer controls the infusion rate of drugs to keep them within pre-established clinical parameters. Objective To describe the technical and clinical performance of a closed loop system for total intravenous anesthesia with propofol and remifentanil, using the SEDLineTM monitor Design Multicentric prospective cohort study Setting Surgery room Patients ASA I-II undergoing elective surgery Measurements The authors designed a closed loop system that implements a control algorithm based on anesthetic depth monitoring and the Patient State Index (PSITM) of the SEDLine monitor for propofol, and on hemodynamic variables for remifentanil. The measurement of clinical performance was made based on the percentage of PSITM maintenance time in the range 20–50. Precision analysis was evaluated by measuring median performance error (MDPE) can be defined as the median difference between actual and desired values, which refers to the degree of precision in which the controller is able to maintain the control variable within the objective set by the anesthesiologist; it represents the direction (over-prediction or under-prediction) of performance error (PE) rather than size of errors, which is represented by MDAPE, median absolute percentage error, Wobble index, which is used for measuring the intrasubject variability in performance error. Results Data were obtained from 93 patients in three healthcare centers. The percentage of PSITM maintenance time in the 20–50 range was 92% (80.7–97.0). MDPE was 10.7 (− 11.0–18.0), MDAPE 21.0 (14.2–26.8) and wobble 10.7 (7.0–16.9). No adverse surgical or anesthetic events were found. Conclusions The closed loop total intravenous anesthesia system with SEDLine developed by the authors was used without major complication and appear to be feasible its use in clinical performance.

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