Optimization of initial propofol bolus dose for <scp>EEG</scp> Narcotrend Index‐guided transition from sevoflurane induction to intravenous anesthesia in children

Dennhardt, Nils; Boethig, Dietmar; Beck, Christiane; Heiderich, Sebastian; Boehne, Martin; Leffler, Andreas; Schultz, Barbara; Sümpelmann, Robert

doi:10.1111/pan.13118

Cited by 18 publications

(14 citation statements)

References 26 publications

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“…In the case of propofol administration, intravenous inhalation of propofol can be performed after sevoflurane or intravenous infusion of propofol can be performed during sevoflurane inhalation anesthesia (12,16). Similar to our study, intravenous infusion of propofol was given after sevoflurane inhalation anesthesia in other studies (18). Costi et al (19) believe that intravenous infusion of propofol at the end of sevoflurane anesthesia is not as effective in reducing the rate of inflammatory response as propofol is infused throughout the anesthesia maintenance process, but administration is more complicated.…”

Section: Discussionsupporting

confidence: 54%

Efficacy and safety of propofol in preventing emergence agitation after sevoflurane anesthesia for children

Cao

Shan

et al. 2019

Exp Ther Med

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Application of propofol in preventing emergence agitation after sevoflurane anesthesia in children was evaluated. Clinical data of 200 children who received sevoflurane anesthesia in Children's Hospital of Xuzhou Medical University were retrospectively analyzed. Among them, 120 patients who received inhaled sevoflurane for pediatric anesthesia and intravenous infusion of propofol (2 mg/kg) were included in observation group. The remaining 80 cases who were directly anesthetized by sevoflurane alone were the control group. T PAED scores, modified Aldrete scores, extubation time, PACU time and adverse reactions (gastrointestinal tract and respiratory response) were analyzed and compared between the control and observation group. PAED scores, extubation time, PACU time and incidence of adverse reactions were significantly lower in observation than in control group, and the modified Aldrete scores were higher in observation than in control group (P<0.05). Spearman's correlation analysis showed that the PAED scores were negatively correlated with modified Aldrete scores and positively correlated with extubation time. There was positive correlation between the PACU time and incidence of adverse reactions and between the PAED scores and extubation time. There was negative correlation between PACU time and incidence of adverse reactions and between Aldrete scores and extubation time (P<0.05). Therefore, we conclude that propofol can be used to prevent agitation after sevoflurane anesthesia in children.

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Section: Discussionsupporting

confidence: 54%

Efficacy and safety of propofol in preventing emergence agitation after sevoflurane anesthesia for children

Cao

Shan

et al. 2019

Exp Ther Med

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“…The correlation between NI and exP is also lower in this study than in studies on adults, where it was about r = 0.7 when compared to Bispectral index (BIS) monitoring [ 17 , 18 ]. It is known from studies in children that children < 2 years display higher NI and greater interindividual variability than children > 2 years [ 19 ]. Nevertheless, the Narcotrend is highly reliable in showing the depth of sedation in children [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Correlation of exhaled propofol with Narcotrend index and calculated propofol plasma levels in children undergoing surgery under total intravenous anesthesia - an observational study

et al. 2021

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Background Exhaled propofol concentrations correlate with propofol concentrations in adult human blood and the brain tissue of rats, as well as with electroencephalography (EEG) based indices of anesthetic depth. The pharmacokinetics of propofol are however different in children compared to adults. The value of exhaled propofol measurements in pediatric anesthesia has not yet been investigated. Breathing system filters and breathing circuits can also interfere with the measurements. In this study, we investigated correlations between exhaled propofol (exP) concentrations and the Narkotrend Index (NI) as well as calculated propofol plasma concentrations. Methods A multi-capillary-column (MCC) combined with ion mobility spectrometry (IMS) was used to determine exP. Optimal positioning of breathing system filters (near-patient or patient-distant) and sample line (proximal or distal to filter) were investigated. Measurements were taken during induction (I), maintenance (M) and emergence (E) of children under total intravenous anesthesia (TIVA). Correlations between ExP concentrations and NI and predicted plasma propofol concentrations (using pediatric pharmacokinetic models Kataria and Paedfusor) were assessed using Pearson correlation and regression analysis. Results Near-patient positioning of breathing system filters led to continuously rising exP values when exP was measured proximal to the filters, and lower concentrations when exP was measured distal to the filters. The breathing system filters were therefore subsequently attached between the breathing system tubes and the inspiratory and expiratory limbs of the anesthetic machine. ExP concentrations significantly correlated with NI and propofol concentrations predicted by pharmacokinetic models during induction and maintenance of anesthesia. During emergence, exP significantly correlated with predicted propofol concentrations, but not with NI. Conclusion In this study, we demonstrated that exP correlates with calculated propofol concentrations and NI during induction and maintenance in pediatric patients. However, the correlations are highly variable and there are substantial obstacles: Without patient proximal placement of filters, the breathing circuit tubing must be changed after each patient, and furthermore, during ventilation, a considerable additional loss of heat and moisture can occur. Adhesion of propofol to plastic parts (endotracheal tube, breathing circle) may especially be problematic during emergence. Trial Registration The study was registered in the German registry of clinical studies (DRKS-ID: DRKS00015795).

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“…Therefore, the Narcotrend ® monitor can make a significant contribution in improving the quality of anesthesia by adjusting the dosage of hypnotics to individual patient needs, also in children. [11][12][13][14][15] Although a critical assessment of EEG-based systems including the Narcotrend ® system still exists, 16 we used the Narcotrend ® system for testing the hypotheses of this study.…”

Section: Discussionmentioning

confidence: 99%

Depth of anesthesia by Narcotrend^® and postoperative characteristics in children undergoing cardiac surgery under extracorporeal circulation: a retrospective comparison of two anesthetic regimens

et al. 2020

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Background: Depth of anesthesia may be insufficient in pediatric cardiac anesthesia if a total intravenous anesthetic regimen with opioids and midazolam is used during cardiopulmonary bypass. The advantages of sevoflurane-based balanced anesthesia may be (1) a more graduated regulation of the depth of anesthesia during cardiopulmonary bypass and (2) a reduction in postoperative ventilation time for children in comparison with total intravenous anesthesia. Aim: To evaluate a possibly positive effect of sevoflurane-based balanced anesthesia in children undergoing cardiac surgery we analyzed whether this anesthetic regimen had a significant effect related to (1) depth of anesthesia, (2) the need for opioids during cardiopulmonary bypass as well as on postoperative characteristics such as (3) time of postoperative ventilation, and (4) duration of stay in the intensive care unit in comparison with total intravenous anesthesia. Methods: In a retrospective analysis, data from heart-lung machine protocols from 2013 to 2016 were compared according to anesthetic regimen (sevoflurane-balanced anesthesia, n = 70 vs. total intravenous anesthesia, n = 65). Children (age: 8 weeks to 14 years) undergoing cardiac surgery with cardiopulmonary bypass were included. As a primary outcome measure, we compared Narcotrend® system–extracted data to detect insufficient phases of anesthetic depth during extracorporeal circulation under moderate hypothermia. Postoperatively, we measured the postoperative ventilation time and the number of days in the intensive care unit. Furthermore, we analyzed patients’ specific characteristics such as opioid consumption during cardiopulmonary bypass. Regression analysis relating primary objectives was done using the following variables: anesthetic regimen, age, severity of illness/surgery, and cumulative dosage of opiates during cardiopulmonary bypass. Results: No significant differences were observed in descriptive patient characteristics (age, body weight, height, and body temperature) between the two groups. Further, no significant differences were found in depth of anesthesia by analyzing phases of superficial B1-C2-electroencephalography Narcotrend® data. No marked difference between the groups was observed for the duration of postoperative intensive care unit stay. However, the postoperative ventilation time (median (95% CI, hours)) was significantly lower in the sevoflurane-based balanced anesthesia group (6.0 (2.0-15.0)) than in the total intravenous anesthesia group (13.5 (7.0-25)). A higher dosage of opioids and midazolam was required in the total intravenous anesthesia group to maintain adequate anesthesia during cardiopulmonary bypass. Regression analysis showed an additional, significant impact of the following factors: severity of illness and severity grade of cardiac surgery (according to Aristotle) on the primary endpoint. Conclusion: In children undergoing cardiac surgery in our department, the use of sevoflurane-balanced anesthesia during cardiopulmonary bypass showed no superiority of inhalational agents over total intravenous anesthesia with opioids and benzodiazepines preventing phases of superficial anesthesia, but a marked advantage for the postoperative ventilation time compared with total intravenous anesthesia.

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Optimization of initial propofol bolus dose for EEG Narcotrend Index‐guided transition from sevoflurane induction to intravenous anesthesia in children

Cited by 18 publications

References 26 publications

Efficacy and safety of propofol in preventing emergence agitation after sevoflurane anesthesia for children

Efficacy and safety of propofol in preventing emergence agitation after sevoflurane anesthesia for children

Correlation of exhaled propofol with Narcotrend index and calculated propofol plasma levels in children undergoing surgery under total intravenous anesthesia - an observational study

Depth of anesthesia by Narcotrend^® and postoperative characteristics in children undergoing cardiac surgery under extracorporeal circulation: a retrospective comparison of two anesthetic regimens

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Optimization of initial propofol bolus dose for EEG Narcotrend Index‐guided transition from sevoflurane induction to intravenous anesthesia in children

Cited by 18 publications

References 26 publications

Efficacy and safety of propofol in preventing emergence agitation after sevoflurane anesthesia for children

Efficacy and safety of propofol in preventing emergence agitation after sevoflurane anesthesia for children

Correlation of exhaled propofol with Narcotrend index and calculated propofol plasma levels in children undergoing surgery under total intravenous anesthesia - an observational study

Depth of anesthesia by Narcotrend® and postoperative characteristics in children undergoing cardiac surgery under extracorporeal circulation: a retrospective comparison of two anesthetic regimens

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Depth of anesthesia by Narcotrend^® and postoperative characteristics in children undergoing cardiac surgery under extracorporeal circulation: a retrospective comparison of two anesthetic regimens