Pasin Laura, Nardelli Pasquale, Pintaudi Margherita, Greco Massimiliano, Zambon Massimo, Cabrini Luca, Zangrillo Alberto
From the Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Anesth Analg. 2017 Feb;124(2):456-464. doi: 10.1213/ANE.0000000000001394.
Bispectral Index Scale (BIS)-guided closed-loop delivery of anesthetics has been extensively studied. We performed a meta-analysis of all the randomized clinical trials comparing efficacy and performance between BIS-guided closed-loop delivery and manually controlled administration of total IV anesthesia. Scopus, PubMed, EMBASE, and the Cochrane Central Register of clinical trials were searched for pertinent studies. Inclusion criteria were random allocation to treatment and closed-loop delivery systems versus manually controlled administration of total IV anesthesia in any surgical setting. Exclusion criteria were duplicate publications and nonadult studies. Twelve studies were included, randomly allocating 1284 patients. Use of closed-loop anesthetic delivery systems was associated with a significant reduction in the dose of propofol administered for induction of anesthesia (mean difference [MD] = 0.37 [0.17-0.57], P for effect <0.00001, P for heterogeneity = 0.001, I = 74%) and a significant reduction in recovery time (MD = 1.62 [0.60-2.64], P for effect <0.0001, P for heterogeneity = 0.06, I = 47%). The target depth of anesthesia was preserved more frequently with closed-loop anesthetic delivery than with manual control (MD = -15.17 [-23.11 to -7.24], P for effect <0.00001, P for heterogeneity <0.00001, I = 83%). There were no differences in the time required to induce anesthesia and the total propofol dose. Closed-loop anesthetic delivery performed better than manual-control delivery. Both median absolute performance error and wobble index were significantly lower in closed-loop anesthetic delivery systems group (MD = 5.82 [3.17-8.46], P for effect <0.00001, P for heterogeneity <0.00001, I = 90% and MD = 0.92 [0.13-1.72], P for effect = 0.003, P for heterogeneity = 0.07, I = 45%). When compared with manual control, BIS-guided anesthetic delivery of total IV anesthesia reduces propofol requirements during induction, better maintains a target depth of anesthesia, and reduces recovery time.
双谱指数（BIS）引导下的麻醉闭环给药已得到广泛研究。我们对所有比较BIS引导下的麻醉闭环给药与全凭静脉麻醉手动控制给药的疗效和性能的随机临床试验进行了荟萃分析。通过检索Scopus、PubMed、EMBASE和Cochrane临床试验中央注册库来查找相关研究。纳入标准为在任何手术环境中随机分配至治疗组以及闭环给药系统与全凭静脉麻醉手动控制给药组。排除标准为重复发表的文献和非成人研究。共纳入12项研究，随机分配了1284例患者。使用闭环麻醉给药系统与麻醉诱导时丙泊酚给药剂量显著降低相关（平均差值[MD]=0.37[0.17 - 0.57]，效应P<0.00001，异质性P = 0.001，I² = 74%），且恢复时间显著缩短（MD = 1.62[0.60 - 2.64]，效应P<0.0001，异质性P = 0.06，I² = 47%）。与手动控制相比，闭环麻醉给药更频繁地维持目标麻醉深度（MD = -15.17[-23.11至 -7.24]，效应P<0.00001，异质性P<0.00001，I² = 83%）。诱导麻醉所需时间和丙泊酚总剂量无差异。闭环麻醉给药的性能优于手动控制给药。闭环麻醉给药系统组的中位绝对性能误差和摆动指数均显著更低（MD = 5.82[3.17 - 8.46]，效应P<0.00001，异质性P<0.00001，I² = 90%；MD = 0.92[0.13 - 1.72]，效应P = 0.003，异质性P = 0.07，I² = 45%）。与手动控制相比，BIS引导下的全凭静脉麻醉给药可减少诱导期间的丙泊酚用量，更好地维持目标麻醉深度，并缩短恢复时间。
