Feasibility of closed-loop co-administration of propofol and remifentanil guided by the bispectral index in obese patients: a prospective cohort comparison

Abstract

NCT00779844.

Model-based drug administration

“…In contrast to dexmedetomidine, they found no sparing effect on both drugs when adding nitrous oxide to the anaesthetic regimen [48]. They also studied the feasibility of their system to determine propofol and remifentanil requirements during general anaesthesia in obese and lean surgical patients and concluded that the amount of propofol-remifentanil administered by the closedloop controller is consistent with current knowledge; propofol is best dosed using total body weight, whereas remifentanil is best dosed using ideal body weight [49]. In children and adolescent patients, their closed-loop system outperformed skilled manual control of propofol and remifentanil [50].…”

Closed-loop Administration of General Anaesthesia: From Sensor to Medical Device

“…The input signal is in all cases derived from the electroencephalographic signal (EEG), the BiSpectral Index ® (Aspect Medical Systems, MA) in some cases [9,39,40], the EEG M-Entropy (GE HealthCare) [41] Technology Co., Ltd., Guangxi, China) [7] is already CE marked and commercially available. All these closed-loop controllers have been developed in order to adapt the propofol administration flow rate to obtain a target EEG index (BIS, SE or Neurosense) value around 50.…”

“…Two devices have already been validated: EasyTIVA ® (Medsteer ® , Suresnes, France) [8,9] and McSleepy ® (McGill university, Québec, Canada) [44]. The analgesic targets differ between these two devices: EasyTIVA ® targets specific changes in a EEG-derived signal that has been related to nociception during surgery under propofol anaesthesia [39], and hence infers therapeutic changes implemented by an automated syringe pump administering a short acting opioid: remifentanil [51].…”

“…On the other hand, a small bolus of remifentanil is performed when a fast decrease of ANIi is observed. device has already been extensively tested and has shown its added value in evaluating non-opioid analgesic drugs and measuring objectively the induced opioid sparing effect [43] or in specific populations where analgesic dosage is difficult, e. g. morbidly obese patients [9]. The closed-loop device for remifentanil administration developed by De Jonckheere J et al has only been tested on a simulated environment [52].…”

“…Simple closed-loops exist in our familiar environment such as central heating machines whose activation is activated/deactivated by room temperature. Adapting therapeutic targets to physiological signals has been applied to several domains of anaesthesia and intensive care: fluid administration [2][3][4], mechanical ventilation [5], general anaesthesia [6][7][8][9], hyperglycemia [10]. General anaesthesia results from the combination of hypnotic and analgesic drugs, sometimes associated to myorelaxants, in order to produce amnesia, analgesia and immobility [11,12].…”