• Anesthesia and analgesia · Mar 2011

    Randomized Controlled Trial Multicenter Study Comparative Study

    Closed-loop coadministration of propofol and remifentanil guided by bispectral index: a randomized multicenter study.

    • Ngai Liu, Thierry Chazot, Sophie Hamada, Alain Landais, Nathalie Boichut, Corinne Dussaussoy, Bernard Trillat, Laurent Beydon, Emmanuel Samain, Daniel I Sessler, and Marc Fischler.
    • Service d'Anesthésie, Hôpital Foch, 40 rue Worth, 92150 Suresnes, France.
    • Anesth. Analg. 2011 Mar 1;112(3):546-57.

    BackgroundWe have developed a proportional-integral-derivative controller allowing the closed-loop coadministration of propofol and remifentanil, guided by a Bispectral Index (BIS) monitor, during induction and maintenance of general anesthesia. The controller was compared with manual target-controlled infusion.MethodsIn a multicenter study, 196 surgical patients were randomly assigned to dual closed-loop or manual administration of propofol and remifentanil. Comparison between groups was evaluated by calculating a global score that characterized the overall performance of the controller including the percentage of adequate anesthesia, defined as BIS between 40 and 60, the median absolute performance error, and wobble. Secondary outcomes included occurrence of burst suppression ratio, time to tracheal extubation, and drug consumption.ResultsEighty-three patients assigned to dual-loop control and 84 patients assigned to manual control completed the study. The global score and the percentage of time with BIS between 40 and 60 were better in the dual-loop group (26 ± 11 vs 43 ± 40, P < 0.0001; 82% ± 12% vs 71% ± 19%, P < 0.0001). Overshoot (BIS <40), undershoot (BIS >60), and burst suppression ratio were all significantly less common in the dual-loop group. Modifications to the propofol and remifentanil infusions were more frequent, and adjustments smaller in the dual-loop group. Remifentanil consumption was greater (0.22 ± 0.07 vs 0.16 ± 0.07 μg · kg(-1) · min(-1); P < 0.0001) and the speed to tracheal extubation was shorter (10 ± 4 vs 11 ± 5 minutes; P = 0.02) in the dual-loop group.ConclusionThe controller allows the automated delivery of propofol and remifentanil and maintains BIS values in predetermined boundaries during general anesthesia better than manual administration.

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