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Feasibility of closed-loop titration of propofol guided by the Bispectral Index for general anaesthesia induction: a prospective randomized study

Published online by Cambridge University Press:  04 April 2006

N. Liu ,
T. Chazot ,
B. Trillat ,
R. Pirracchio ,
J.-D. Law-Koune ,
L. Barvais  and
M. Fischler
N. Liu
Affiliation:
Hôpital Foch, Department of Anaesthesiology, Suresnes, France
T. Chazot
Affiliation:
Hôpital Foch, Department of Anaesthesiology, Suresnes, France
B. Trillat
Affiliation:
Hôpital Foch, Informatics, Suresnes, France
R. Pirracchio
Affiliation:
Hôpital Foch, Department of Anaesthesiology, Suresnes, France
J.-D. Law-Koune
Affiliation:
Hôpital Foch, Department of Anaesthesiology, Suresnes, France
L. Barvais
Affiliation:
Hôpital Erasme ULB, Department of Anaesthesiology, Brussels, Belgium
M. Fischler
Affiliation:
Hôpital Foch, Department of Anaesthesiology, Suresnes, France
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Extract

Summary

Background: This study was designed to evaluate the feasibility of propofol infusion by a closed-loop system for the titration of anaesthetic induction guided by Bispectral Index. Methods: Forty patients were prospectively and randomly allocated into two groups: the target control infusion (TCI) group, where propofol titration was performed manually guided by the Bispectral Index using a commercial pharmacokinetic model (Diprifusor device) and the closed-loop group where titration was performed using a proportional differential algorithm. For both groups, the objective was to achieve a Bispectral Index of 50. Remifentanil TCI was infused at a target of 2 ng mL−1 and was maintained constant throughout the study. Feasibility of automatic induction was evaluated with performance error and haemodynamic data. Results: Bispectral Index overshoot (−9 ± 13% vs. −16 ± 20%, P = 0.035) and mean duration of induction (381 ± 106 s vs. 490 ± 131 s, P = 0.004) were lower in the closed-loop group than in the TCI group. Haemodynamic data were similar between groups with a similar use of ephedrine bolus. Conclusion: The system was able to allow induction clinically for all patients. Automated titration guided by Bispectral Index for propofol infusion was feasible without increase in haemodynamic adverse effects.

Keywords

ANAESTHESIA, INTRAVENOUS, depth of anaesthesia, Bispectral IndexANAESTHETICS INTRAVENOUS, propofolANALGESICS OPIOID, remifentanilDRUG DELIVERY SYSTEMS, closed-loop control
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 6 , June 2006 , pp. 465 - 469
Copyright
© 2006 European Society of Anaesthesiology

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