TY - JOUR
T1 - Unwanted spontaneous responsiveness and burst suppression in patients undergoing entropy-guided total intravenous anesthesia with target-controlled infusion
T2 - An observational prospective trial
AU - Linassi, Federico
AU - Kreuzer, Matthias
AU - Kratzer, Stephan
AU - Olivieri, Sara
AU - Zanatta, Paolo
AU - Schneider, Gerhard
AU - Carron, Michele
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2023/6
Y1 - 2023/6
N2 - Study objective: To estimate the incidence of unwanted spontaneous responsiveness and burst suppression (BSupp) in patients undergoing state entropy (SE) and surgical pleth index (SPI)-guided total intravenous anesthesia (TIVA) with target-controlled infusion (TCI). Design: Observational, prospective, single-center study. Settings: Operating room. Patients: 107 adult (<65 years) and elderly (≥65 years) women undergoing breast surgery. Interventions: Propofol-remifentanil TIVA-TCI-guided by SE for depth of anesthesia monitoring (target value 40–60) and SPI for antinociception monitoring (target value 20–50) without neuromuscular blockade. Measurements: Age; body mass index; American Society of Anesthesiologists physical status classification; concentration at the effect site of propofol (CeP) and remifentanil (CeR) at loss of responsiveness (LoR), median during anesthesia maintenance (MdM), and at return of responsiveness (RoR); propofol infusion duration; incidence of postoperative delirium (POD) with Confusing Assessment Method for the Intensive Care Unit. Main results: During SE-SPI-guided TIVA-TCI, 13.1% of patients showed unwanted spontaneous responsiveness, whereas 45.8% showed BSupp. Unwanted spontaneous responsiveness was observed mainly in adults (p < 0.05), and higher CeP RoR (p < 0.05) was registered. BSupp was observed mainly in patients showing a lower CeP MdM (p < 0.01) and CeP RoR (p < 0.05). Unwanted spontaneous responsiveness and BSupp were not associated with significant differences in CeRs. An age-related hysteresis effect was observed, resulting in higher CeP LoR than CeP RoR (p < 0.001). 12.2% of patients showed POD. Only preoperative serum albumin was associated with increased likelihood of POD (p = 0.046). Conclusions: The SE-SPI-guided TIVA-TCI did not prevent unwanted spontaneous responsiveness and BSupp. CeP RoR may be used as a proxy for anesthetic sensitivity.
AB - Study objective: To estimate the incidence of unwanted spontaneous responsiveness and burst suppression (BSupp) in patients undergoing state entropy (SE) and surgical pleth index (SPI)-guided total intravenous anesthesia (TIVA) with target-controlled infusion (TCI). Design: Observational, prospective, single-center study. Settings: Operating room. Patients: 107 adult (<65 years) and elderly (≥65 years) women undergoing breast surgery. Interventions: Propofol-remifentanil TIVA-TCI-guided by SE for depth of anesthesia monitoring (target value 40–60) and SPI for antinociception monitoring (target value 20–50) without neuromuscular blockade. Measurements: Age; body mass index; American Society of Anesthesiologists physical status classification; concentration at the effect site of propofol (CeP) and remifentanil (CeR) at loss of responsiveness (LoR), median during anesthesia maintenance (MdM), and at return of responsiveness (RoR); propofol infusion duration; incidence of postoperative delirium (POD) with Confusing Assessment Method for the Intensive Care Unit. Main results: During SE-SPI-guided TIVA-TCI, 13.1% of patients showed unwanted spontaneous responsiveness, whereas 45.8% showed BSupp. Unwanted spontaneous responsiveness was observed mainly in adults (p < 0.05), and higher CeP RoR (p < 0.05) was registered. BSupp was observed mainly in patients showing a lower CeP MdM (p < 0.01) and CeP RoR (p < 0.05). Unwanted spontaneous responsiveness and BSupp were not associated with significant differences in CeRs. An age-related hysteresis effect was observed, resulting in higher CeP LoR than CeP RoR (p < 0.001). 12.2% of patients showed POD. Only preoperative serum albumin was associated with increased likelihood of POD (p = 0.046). Conclusions: The SE-SPI-guided TIVA-TCI did not prevent unwanted spontaneous responsiveness and BSupp. CeP RoR may be used as a proxy for anesthetic sensitivity.
KW - Age
KW - Burst suppression
KW - General anesthesia
KW - Target controlled infusion
KW - Unwanted spontaneous responsiveness
UR - http://www.scopus.com/inward/record.url?scp=85147373939&partnerID=8YFLogxK
U2 - 10.1016/j.jclinane.2022.111045
DO - 10.1016/j.jclinane.2022.111045
M3 - Article
C2 - 36680980
AN - SCOPUS:85147373939
SN - 0952-8180
VL - 86
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
M1 - 111045
ER -