• Anesthesiology · Feb 2012

    Randomized Controlled Trial Comparative Study

    Feasibility of closed-loop titration of propofol and remifentanil guided by the spectral M-Entropy monitor.

    • Ngai Liu, Morgan Le Guen, Fatima Benabbes-Lambert, Thierry Chazot, Bernard Trillat, Daniel I Sessler, and Marc Fischler.
    • Service d'Anesthésie, Hôpital Foch, Suresnes, France.
    • Anesthesiology. 2012 Feb 1;116(2):286-95.

    BackgroundThis randomized controlled trial describes automated coadministration of propofol and remifentanil, guided by M-Entropy analysis of the electroencephalogram. The authors tested the hypothesis that a novel dual-loop controller with an M-Entropy monitor increases time spent within predetermined target entropy ranges.MethodsPatients scheduled for elective surgery were randomly assigned in this single-blind study using a computer-generated list, to either dual-loop control using a proportional-integral-derivative controller or skilled manual control of propofol and remifentanil using target-controlled-infusion systems. In each group, propofol and remifentanil administration was titrated to a state entropy target of 50 and was subsequently targeted to values between 40 and 60. The primary outcome was the global score, which included the percentage of state entropy or response entropy in the range 40-60, the median absolute performance error and wobble. Data are presented as medians [interquartile range].ResultsThirty patients assigned to the dual-loop group and 31 assigned to the manual group completed the study. The dual-loop controller was able to provide induction and maintenance for all patients. The Global Score of State Entropy was better maintained with dual-loop than manual control (25 [19-53] vs. 44 [25-110], P = 0.043), and state entropy was more frequently maintained in the range of 40-60 (80 [60-85] vs. 60 [35-82]%, P = 0.046). Propofol (4.1 [2.9-4.9] vs. 4.5 [3.4-6.3] mg · kg(-1) · h(-1)) and remifentanil (0.18 [0.13-0.24] vs. 0.19 [0.15-0.26] μg · kg(-1) · min(-1)) consumptions and the incidence of somatic side effects were similar.ConclusionIntraoperative automated control of hypnosis and analgesia guided by M-Entropy is clinically feasible and more precise than skilled manual control.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    This article appears in the collection: Closed-loop anesthesia delivery.

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…