Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium.
J Clin Monit Comput. 2022 Oct;36(5):1407-1422. doi: 10.1007/s10877-021-00781-2. Epub 2021 Nov 26.
Current trends in anesthetic depth (i.e., hypnosis) and antinociception monitoring are unclear. We thus aimed to determine contemporary perspectives on monitoring these components of anesthesia during general anesthesia. Participants received and responded anonymously to an internet-based international survey supported by the European Society of Anaesthesiology and Intensive Care. Comparisons, when applicable, were carried out using Chi analysis or Fischer's exact test. A total of 564 respondents, predominantly from Europe (80.1%), participated. There was a strong participation from Belgium (11.5%). A majority (70.9%) of anesthetists considered hypnotic monitoring important on most occasions to always. In contrast, a majority (62.6%) never or only occasionally considered antinociception monitoring important. This difference in the perceived importance of anesthetic depth versus antinociception monitoring was significant (p < 0.0001). A majority of respondents (70.1%) believed that guiding hypnosis and antinociception using these monitors would improve patient care on most occasions to always. Nonetheless, a substantial number of participants were unsure if hypnotic (23%) or antinociception (32%) monitoring were recommended and there was a lack of knowledge (58%) of any published algorithms to titrate hypnotic and/or antinociceptive drugs based on the information provided by the monitors. In conclusion, current trends in European academic centers prioritize anesthesia depth over antinociception monitoring. Despite an agreement among respondents that applying strategies that optimize anesthetic depth and antinociception could improve outcome, there remains a lack of knowledge of appropriate algorithms. Future studies and recommendations should focus on clarifying goal-directed anesthetic strategies and determine their impact on perioperative patient outcome.
目前麻醉深度（即催眠）和镇痛监测的趋势尚不清楚。因此，我们旨在确定当前对全身麻醉期间监测这些麻醉成分的看法。参与者匿名在线参与了一项由欧洲麻醉学会和重症监护医学学会支持的国际调查。在适用的情况下，使用 Chi 分析或 Fischer 精确检验进行比较。共有 564 名应答者主要来自欧洲（80.1%），比利时的应答者占 11.5%。大多数麻醉师（70.9%）认为催眠监测在大多数情况下始终很重要。相比之下，大多数（62.6%）麻醉师认为镇痛监测不重要，要么从不监测，要么仅偶尔监测。麻醉深度与镇痛监测的重要性之间存在显著差异（p<0.0001）。大多数应答者（70.1%）认为，大多数情况下，使用这些监测仪指导催眠和镇痛会改善患者的护理。尽管大多数参与者不确定是否推荐使用催眠（23%）或镇痛（32%）监测，而且对于基于监测仪提供的信息滴定催眠和/或镇痛药物的任何公布算法都缺乏了解（58%）。总之，目前欧洲学术中心的趋势优先考虑麻醉深度，而不是镇痛监测。尽管应答者一致认为应用优化麻醉深度和镇痛的策略可以改善结果，但仍然缺乏适当算法的知识。未来的研究和建议应侧重于阐明目标导向的麻醉策略，并确定其对围手术期患者结果的影响。
