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- Title
Robust closed-loop control of induction and maintenance of propofol anesthesia in children.
- Authors
West, Nicholas; Dumont, Guy A.; Heusden, Klaske; Petersen, Christian L.; Khosravi, Sara; Soltesz, Kristian; Umedaly, Aryannah; Reimer, Eleanor; Ansermino, J. Mark; Davidson, Andrew
- Abstract
Background During closed-loop control, a drug infusion is continually adjusted according to a measure of clinical effect (e.g., an electroencephalographic depth of hypnosis ( Do H) index). Inconsistency in population-derived pediatric pharmacokinetic/pharmacodynamic models and the large interpatient variability observed in children suggest a role for closed-loop control in optimizing the administration of intravenous anesthesia. Objective To clinically evaluate a robustly tuned system for closed-loop control of the induction and maintenance of propofol anesthesia in children undergoing gastrointestinal endoscopy. Methods One hundred and eight children, aged 6-17, ASA I- II, were enrolled. Prior to induction of anesthesia, Neuro SENSE™ sensors were applied to obtain the WAVCNS Do H index. An intravenous cannula was inserted and lidocaine (0.5 mg·kg−1) administered. Remifentanil was administered as a bolus (0.5 μg·kg−1), followed by continuous infusion (0.03 μg·kg−1·min−1). The propofol infusion was closed-loop controlled throughout induction and maintenance of anesthesia, using WAVCNS as feedback. Results Anesthesia was closed-loop controlled in 102 cases. The system achieved and maintained an adequate Do H without manual adjustment in 87/102 (85%) cases. Induction of anesthesia (to WAVCNS ≤ 60) was completed in median 3.8 min (interquartile range ( IQR) 3.1-5.0), culminating in a propofol effect-site concentration ( Ce) of median 3.5 μg·ml−1 ( IQR 2.7-4.5). During maintenance of anesthesia, WAVCNS was measured within 10 units of the target for median 89% ( IQR 79-96) of the time. Spontaneous breathing required no manual intervention in 91/102 (89%) cases. Conclusions A robust closed-loop system can provide effective propofol administration during induction and maintenance of anesthesia in children. Wide variation in the calculated Ce highlights the limitation of open-loop regimes based on pharmacokinetic/pharmacodynamic models.
- Subjects
CLOSED loop systems; PROPOFOL; PEDIATRIC anesthesia; ENDOSCOPY; CATHETERS; PHARMACOKINETICS; PHARMACODYNAMICS
- Publication
Pediatric Anesthesia, 2013, Vol 23, Issue 8, p712
- ISSN
1155-5645
- Publication type
Article
- DOI
10.1111/pan.12183