Liu Ngai, Chazot Thierry, Genty Antoine, Landais Alain, Restoux Aymeric, McGee Kathleen, Laloë Pierre-Antoine, Trillat Bernard, Barvais Luc, Fischler Marc
Department of Anesthesiology, Hôpital Foch, Suresnes, France.
Anesthesiology. 2006 Apr;104(4):686-95. doi: 10.1097/00000542-200604000-00012.
This report describes a closed-loop titration of propofol target control infusion based on a proportional-differential algorithm guided by the Bispectral Index (BIS) allowing induction and maintenance of general anesthesia and compares this to manual propofol target control infusion.
One hundred sixty-four patients scheduled to undergo elective minor or major surgery were prospectively randomized in a multicenter study into the closed-loop (n = 83) or manual target control infusion group (n = 81). The goal was to reach a BIS target of 50 during induction and to maintain it between 40 and 60 during maintenance. For both groups, remifentanil target control infusion was adjusted manually, and ventilation was without nitrous oxide.
Closed-loop control was able to provide anesthesia induction and maintenance for all patients. During induction, propofol consumption was lower in the closed-loop group (1.4 +/- 0.5 vs. 1.8 +/- 0.6 mg/kg; P < 0.0001), but the duration was longer (320 +/- 125 vs. 271 +/- 120 s; P < 0.0002). Adequate anesthesia maintenance, defined as the BIS in the range of 40-60, was significantly higher in the closed-loop group (89 +/- 9 vs. 70 +/- 21%; P < 0.0001), with a decrease of the occurrence of BIS less than 40 (8 +/- 8 vs. 26 +/- 22%; P < 0.0001). Time from discontinuation of propofol infusion to tracheal extubation was shorter in the closed-loop group (7 +/- 4 vs. 10 +/- 7 min; P < 0.017). Unwanted somatic events and hemodynamic instability were similar.
Automatic control of consciousness using the BIS is clinically feasible and outperforms manual control.
本报告描述了一种基于双谱指数（BIS）的比例 - 微分算法的丙泊酚靶控输注闭环滴定法，用于全身麻醉的诱导和维持，并将其与手动丙泊酚靶控输注进行比较。
在一项多中心研究中，164例计划进行择期小手术或大手术的患者被前瞻性随机分为闭环组（n = 83）或手动靶控输注组（n = 81）。目标是在诱导期间达到BIS目标值50，并在维持期间将其维持在40至60之间。对于两组，瑞芬太尼靶控输注均手动调整，通气时不使用氧化亚氮。
闭环控制能够为所有患者提供麻醉诱导和维持。在诱导期间，闭环组丙泊酚消耗量较低（1.4±0.5 vs. 1.8±0.6 mg/kg；P < 0.0001），但持续时间较长（320±125 vs. 271±120 s；P < 0.0002）。定义为BIS在40 - 60范围内的充分麻醉维持，在闭环组中显著更高（89±9 vs. 70±21%；P < 0.0001），BIS低于40的发生率降低（8±8 vs. 26±22%；P < 0.0001）。闭环组从停止丙泊酚输注到气管拔管的时间更短（7±4 vs. 10±7 min；P < 0.017）。不良躯体事件和血流动力学不稳定情况相似。
使用BIS自动控制意识在临床上是可行的，并且优于手动控制。
