Robust closed‐loop control of induction and maintenance of propofol anesthesia in children. Issue 8 (13th May 2013)

• Record Type: Journal Article
• Authors: West, Nicholas; Dumont, Guy A.; van, Klaske; Petersen, Christian L.; Khosravi, Sara; Soltesz, Kristian; Umedaly, Aryannah; Reimer, Eleanor; Ansermino, J. Mark; Davidson, Andrew
• Is Part Of: Paediatric anaesthesia. Volume 23:Issue 8(2013)
• Page Start: 712
• Page End: 719
• Publication Date: 2013-05-13
• Subjects: Pediatric anesthesia -- Periodicals; 617.96798
• DOI: 10.1111/pan.12183
• Languages: English
• ISSNs: 1155-5645

Abstract

<abstract abstract-type="main" xml:lang="en" id="pan12183-abs-0001"> <title>Summary</title> <sec id="pan12183-sec-0001" sec-type="section"> <title>Background</title> <p>During closed‐loop control, a drug infusion is continually adjusted according to a measure of clinical effect (e.g., an electroencephalographic depth of hypnosis (DoH) index). Inconsistency in population‐derived pediatric pharmacokinetic/pharmacodynamic models and the large interpatient variability observed in children suggest a role for closed‐loop control in optimizing the administration of intravenous anesthesia.</p> </sec> <sec id="pan12183-sec-0002" sec-type="section"> <title>Objective</title> <p>To clinically evaluate a robustly tuned system for closed‐loop control of the induction and maintenance of propofol anesthesia in children undergoing gastrointestinal endoscopy.</p> </sec> <sec id="pan12183-sec-0003" sec-type="section"> <title>Methods</title> <p>One hundred and eight children, aged 6–17, ASA I‐II, were enrolled. Prior to induction of anesthesia, NeuroSENSE™ sensors were applied to obtain the WAV<sub>CNS</sub> DoH index. An intravenous cannula was inserted and lidocaine (0.5 mg·kg<sup>−1</sup>) administered. Remifentanil was administered as a bolus (0.5 μg·kg<sup>−1</sup>), followed by continuous infusion (0.03 μg·kg<sup>−1</sup>·min<sup>−1</sup>). The propofol infusion was closed‐loop controlled throughout induction and maintenance of anesthesia, using WAV<sub>CNS</sub> as feedback.</p> </sec> <sec id="pan12183-sec-0004" sec-type="section"> <title>Results</title> <p>Anesthesia was closed‐loop controlled in 102 cases. The system achieved and maintained an adequate DoH without manual adjustment in 87/102 (85%) cases. Induction of anesthesia (to WAV<sub>CNS</sub> ≤ 60) was completed in median 3.8 min (interquartile range (IQR) 3.1–5.0), culminating in a propofol effect‐site concentration (<italic>C</italic><sub>e</sub>) of median 3.5 μg·ml<sup>−1</sup> (IQR 2.7–4.5). During maintenance of anesthesia, WAV<sub>CNS</sub> was measured within 10 units of the target for median 89% (IQR 79–96) of the time. Spontaneous breathing required no manual intervention in 91/102 (89%) cases.</p> </sec> <sec id="pan12183-sec-0005" sec-type="section"> <title>Conclusions</title> <p>A robust closed‐loop system can provide effective propofol administration during induction and maintenance of anesthesia in children. Wide variation in the calculated <italic>C</italic><sub>e</sub> highlights the limitation of open‐loop regimes based on pharmacokinetic/pharmacodynamic models.</p> </sec> </abstract>