Unwanted spontaneous responsiveness and burst suppression in patients undergoing entropy-guided total intravenous anesthesia with target-controlled infusion: An observational prospective trial

Linassi, Federico; Kreuzer, Matthias; Kratzer, Stephan; Olivieri, Sara; Zanatta, Paolo; Schneider, Gerhard; Carron, Michele

doi:10.1016/j.jclinane.2022.111045

Cited by 2 publications

(5 citation statements)

References 65 publications

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“…The values of the SPI range from 0 to 100. Maintaining a value between 20 and 50 is generally recommended during general anesthesia in adult patients [7][8][9] and this was the target in this study.…”

Section: General Anesthesiamentioning

confidence: 99%

“…The primary endpoint was to evaluate the difference in CePs during anesthesia performed with the Schnider and Eleveld models. The secondary endpoints were to evaluate the difference in the incidence of unwanted events during anesthesia performed with the two PK/PD models: lightening of anesthesia event (LAE), defined as BIS > 60 [6]; deepening of anesthesia event (DAE), defined as BIS < 40 [6]; unwanted spontaneous responsiveness event, defined as any involuntary movement (i.e., movement of extremities) or somatic reaction (i.e., coughing, chewing, grimacing, breathing against a ventilator, or inadequate ventilation because of vocal cord closure) in combination with a significant hemodynamic response (i.e., tachycardia (>100 bpm) and hypertension (mean arterial pressure > 120% of baseline or mean arterial pressure ≥ 100 mmHg)) during anesthesia maintenance [7][8][9]; a burst suppression event (BSE), which is defined as a burst suppression ratio > 0. To avoid false positives occurring at low BSR values, according to the literature, BSR > 5% was chosen.…”

Section: Clinical Endpoints and Variablesmentioning

confidence: 99%

“…To avoid false positives occurring at low BSR values, according to the literature, BSR > 5% was chosen. Thus, a BSE was therefore defined as a BSR >5% episode, which means at least 3 s of suppressed activity in 1 min of EEG activity [9,20,21].…”

Section: Clinical Endpoints and Variablesmentioning

confidence: 99%

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Schnider and Eleveld Models for Propofol Target-Controlled Infusion Anesthesia: A Clinical Comparison

Linassi,

Zanatta,

Spano

et al. 2023

Life

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Background: Various pharmacokinetic/pharmacodynamic (PK/PD) models have been developed to accurately dose propofol administration during total intravenous anesthesia with target-controlled infusion (TIVA-TCI). We aim to clinically compare the performance of the Schnider model and the new and general-purpose Eleveld PK/PD model during TIVA-TCI. Methods: We conducted a prospective observational study at a single center, enrolling 78 female patients, including 37 adults (aged < 65 years) and 41 elderly patients (aged ≥ 65 years). These patients underwent breast surgery with propofol-remifentanil TIVA-TCI guided by the bispectral index (BIS) for depth of anesthesia monitoring (target value 40–60) and the surgical plethysmographic index (SPI) for antinociception monitoring (target value 20–50) without neuromuscular blockade. The concentration at the effect site of propofol (CeP) at loss of responsiveness (LoR) during anesthesia maintenance (MA) and at return of responsiveness (RoR), the duration of surgery and anesthesia (min), the time to RoR (min), the propofol total dose (mg), the deepening of anesthesia events (DAEs), burst suppression events (BSEs), light anesthesia events (LAEs) and unwanted spontaneous responsiveness events (USREs) were considered to compare the two PK/PD models. Results: Patients undergoing BIS-SPI-guided TIVA-TCI with the Eleveld PK/PD model showed a lower CeP at LoR (1.7 (1.36–2.25) vs. 3.60 (3.00–4.18) μg/mL, p < 0.001), higher CePMA (2.80 (2.55–3.40) vs. 2.30 (1.80–2.50) μg/mL, p < 0.001) and at RoR (1.48 (1.08–1.80) vs. 0.64 (0.55–0.81) μg/mL, p < 0.001) than with the Schnider PK/PD model. Anesthetic hysteresis was observed only in the Schnider PK/PD model group (p < 0.001). DAEs (69.2% vs. 30.8%, p = 0.001) and BSEs (28.2% vs. 5.1%, p = 0.013) were more frequent with the Eleveld PK/PD model than with the Schnider PK/PD model in the general patient population. DAEs (63.2% vs. 27.3%, p = 0.030) and BSEs (31.6% vs. 4.5%, p = 0.036) were more frequent with the Eleveld PK/PD model than with the Schnider PK/PD model in the elderly. Conclusions: The Schnider and Eleveld PK/PD models impact CePs differently. A greater incidence of DAEs and BSEs in the elderly suggests more attention is necessary in this group of patients undergoing BIS-SPI-guided TIVA-TCI with the Eleveld PK/PD than with the Schnider model.

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Section: General Anesthesiamentioning

confidence: 99%

Section: Clinical Endpoints and Variablesmentioning

confidence: 99%

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Schnider and Eleveld Models for Propofol Target-Controlled Infusion Anesthesia: A Clinical Comparison

Linassi,

Zanatta,

Spano

et al. 2023

Life

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“…4 Furthermore, a previous study showed that both vasopressor use and the requirement for opioids were lower when a combination of Entropy monitoring and SPI guidance of anesthesia was used instead of standard care. 5 A systematic review and meta-analysis revealed that S-ketamine, which provides both analgesia and sedation, could be used to relieve acute postoperative pain. 6 In addition, a study by Mastrodonato et al 7 showed that S-ketamine protects against inflammatory stressors.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of S-ketamine on the intraoperative Surgical Pleth Index in patients undergoing video-assisted thoracoscopic surgery: a single-center randomized controlled clinical trial

Chen,

Zhu,

Peng

et al. 2023

J Int Med Res

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Objective To investigate whether S-ketamine affects the Surgical Pleth Index (SPI) during video-assisted thoracoscopic surgery. Methods Eighty-four patients undergoing video-assisted thoracoscopic lung lobectomy were enrolled. They were randomly assigned to an S-ketamine group (group S) and an equivalent normal saline group (group N). SPI values were recorded; and pain score on a numerical rating scale (NRS), the consumption of opioids, rescue analgesia, and post-operative nausea and vomiting (PONV) were evaluated. Results The SPI and heart rate of the S-ketamine group were significantly lower 30 minutes after the start of surgery and at the end. The NRS score was lower in the S-ketamine group 6 and 12 hours postoperatively, but there were no differences in mean blood pressure or the NRS score 24 and 48 hours postoperatively. Rescue analgesia was required less frequently by the S-ketamine group, but the incidence of PONV did not differ between the groups. Conclusions S-ketamine was associated with lower intraoperative SPI 30 minutes after the start and at the end of surgery. It also reduced opioid use intraoperatively and the NRS scores 6 and 12 hours postoperatively. Trial registration: Chinese Clinical Trial Registry (ChiCTR2000040012), 18/11/2020.

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Unwanted spontaneous responsiveness and burst suppression in patients undergoing entropy-guided total intravenous anesthesia with target-controlled infusion: An observational prospective trial

Cited by 2 publications

References 65 publications

Schnider and Eleveld Models for Propofol Target-Controlled Infusion Anesthesia: A Clinical Comparison

Schnider and Eleveld Models for Propofol Target-Controlled Infusion Anesthesia: A Clinical Comparison

Effect of S-ketamine on the intraoperative Surgical Pleth Index in patients undergoing video-assisted thoracoscopic surgery: a single-center randomized controlled clinical trial

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