Weber Frank, Walhout Laurence C, Escher Johanna C
Department of Anaesthesiology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Paediatrics, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
Paediatr Anaesth. 2018 May;28(5):443-449. doi: 10.1111/pan.13365. Epub 2018 Mar 25.
Propofol is often used for procedural sedation in children undergoing gastrointestinal endoscopy. Reliable assessment of the depth of hypnosis during the endoscopic procedure is challenging. Processed electroencephalography using the Narcotrend Index can help titrating propofol to a predefined sedation level.
The aim of this trial was to investigate the impact of Narcotrend Index-guided titration of propofol delivery on the speed of recovery.
Children, aged 12-17 years, undergoing gastrointestinal endoscopy under procedural sedation, had propofol delivered via target controlled infusion either based on Narcotrend Index guidance (group NI) or standard clinical parameters (group C). Sedation was augmented with remifentanil in both study groups. The primary endpoint of this study was to compare the speed of fulfilling discharge criteria from the operating room between study groups. Major secondary endpoints were propofol consumption, discharge readiness from the recovery room, hypnotic depth as measured by the Narcotrend Index, and adverse events.
Of the 40 children included, data were obtainable from 37. The time until discharge readiness from the operating room was shorter in group NI than in group C, with a difference between medians of 4.76 minutes [95%CI 2.6 to 7.4 minutes]. The same accounts for recovery room discharge times; difference between medians 4.03 minutes [95%CI 0.81 to 7.61 minutes]. Propofol consumption and the percentage of EEG traces indicating oversedation were higher in group C than in group NI. There were no significant adverse events in either study group.
Narcotrend Index guidance of propofol delivery for deep sedation in children aged 12-17 years, underdoing gastrointestinal endoscopy results in faster recovery, less drug consumption, and fewer episodes of oversedation than dosing propofol according to clinical surrogate parameters of depth of hypnosis. The results of this study provide additional evidence in favor of the safety profile of propofol/remifentanil for procedural sedation in adequately selected pediatric patients.
丙泊酚常用于接受胃肠内镜检查的儿童的程序性镇静。在内镜检查过程中，可靠评估催眠深度具有挑战性。使用脑电双频指数（Narcotrend指数）处理脑电图有助于将丙泊酚滴定至预定义的镇静水平。
本试验的目的是研究Narcotrend指数引导的丙泊酚给药滴定对恢复速度的影响。
12至17岁接受程序性镇静下胃肠内镜检查的儿童，通过靶控输注给予丙泊酚，要么基于Narcotrend指数引导（NI组），要么基于标准临床参数（C组）。两个研究组均使用瑞芬太尼增强镇静效果。本研究的主要终点是比较研究组之间达到从手术室出院标准的速度。主要次要终点包括丙泊酚消耗量、从恢复室准备出院情况、通过Narcotrend指数测量的催眠深度以及不良事件。
纳入的40名儿童中，37名可获得数据。NI组从手术室准备出院的时间比C组短，中位数差异为4.76分钟[95%置信区间2.6至7.4分钟]。恢复室出院时间也是如此；中位数差异为4.03分钟[95%置信区间0.81至7.61分钟]。C组的丙泊酚消耗量和脑电图显示过度镇静的百分比高于NI组。两个研究组均未发生显著不良事件。
对于12至17岁接受胃肠内镜检查的儿童，在深度镇静时，与根据催眠深度的临床替代参数给予丙泊酚相比，Narcotrend指数引导丙泊酚给药可使恢复更快、药物消耗更少且过度镇静发作更少。本研究结果为丙泊酚/瑞芬太尼用于适当选择的儿科患者程序性镇静的安全性提供了更多证据。
