Safety and efficacy of an automated anesthesia delivery system for total intravenous anesthesia with propofol, remifentanil, and rocuronium: a non-inferiority randomized controlled trial versus manually controlled anesthesia

Nagata, Osamu; Matsuki, Yuka; Ogino, Yoshihiro; Shigemi, Kenji

doi:10.1007/s00540-021-03015-6

Cited by 10 publications

(21 citation statements)

References 6 publications

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“…As a minimally invasive technique, laparoscopic operation (LO) has been widely used in the surgical field due to its advantages such as less incision bleeding, less trauma, and quick post-operative recovery and has gradually changed some traditional treatment methods in pediatric surgery, as shown in Figure 1 . Although a large number of studies have shown that the degree of stress caused by laparoscopic surgery is less than the conventional laparotomy, but that caused by co 2 pneumoperitoneum intra-abdominal pressure, carbon dioxide-absorbed hypercapnia, and surgery at the end of the internal pressure drop similar ischemia and reperfusion injury factors can induce the body's stress response [ 1 ]. This can lead to changes in endocrine metabolism, triggering an inflammatory immune response.…”

Section: Introductionmentioning

confidence: 99%

[Retracted] Application of Intravenous Anesthesia in Laparoscopic Hiatal Hernia Repair of Children

Zhu

Yang

et al. 2022

Contrast Media & Molecular Imaging

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In order to solve the stress problem in laparoscopic hiatal hernia repair of children, improve surgical safety, and reduce surgical risk, this study compared the perioperative changes of epinephrine, norepinephrine, IL-6, IL-10, and hemodynamics in children undergoing laparoscopic surgery under intravenous general anesthesia and general anesthesia combined with an epidural block. In this study, 40 children aged 1–3 years who planned to undergo laparoscopic ortopexy and those who planned to undergo laparoscopic high ligation of hernia sac, aged 23.84 1.6 months and weighed 14.9 1.1 kg, were randomly divided into general anesthesia combined with the epidural block group (group A) and a total intravenous anesthesia group (group B), with 20 subjects in each group. The results are as follows: There were no differences in age, gender, body weight, anesthesia time, pneumoperitoneum duration, and functional time between the two groups. Cytokines: Compared with T0, the levels of IL-6 in T2, T3, T4, and T5 groups were significantly increased ( P < 0.01). IL-10 levels: T2, T3, T4, and T5 groups were further increased, and the difference was statistically significant compared with T0 ( P < 0.01). There was no difference between groups ( P > 0.05). The recovery time in group B was shorter than that in group A ( P < 0.01), and the total amount of propofol and fentanyl in group B was less than that in group A ( P < 0.01). Through research on intravenous anesthesia treatment, it has been proved that total intravenous anesthesia can relieve perioperative pressure, reduce intravenous injection, and reduce the recovery time of children. However, its effect on cytokines is not obvious, so intravenous anesthesia is the most appropriate anesthesia mode in laparoscopic hiatal hernia repair surgery, which has practical significance.

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Section: Introductionmentioning

confidence: 99%

[Retracted] Application of Intravenous Anesthesia in Laparoscopic Hiatal Hernia Repair of Children

Zhu

Yang

et al. 2022

Contrast Media & Molecular Imaging

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“…In fact, the system we developed allowed changes in the analgesic infusion rate based on this algorithm to ensure a stable analgesic state. 4 This also shows that the necessary analgesic concentrations estimated with drug-drug interactions do not contradict those determined at anesthesiologists' discretion and can be considered a practical approach for ensuring a reasonable analgesic state.…”

Section: Discussionmentioning

confidence: 76%

“…3 Meanwhile, due to the presence of analgesic-sedative interactions and the presence of interactions between esTEC and opioid concentration, as shown in the curve convex below, it may be possible to use this relationship to estimate the opioid concentrations that provide an adequate analgesic effect in a particular patient at individual time points and to measure analgesic effects objectively. 4 However, there has never been an examination of whether the objectively determined reasonable opioid concentration that provides analgesic effects is the same as the opioid concentration administered at anesthesiologists' discretion.…”

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confidence: 99%

Good correlation between necessary remifentanil concentrations in individual patients determined from sedative-analgesic interactions using pharmacokinetic simulations and the remifentanil concentrations used at anesthesiologists’ discretion

Matsuki

Nagata

Shigemi

2023

Preprint

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Background Analgesic and sedative agents interact with each other, and their relationship is explained in a curve convex below. In the automated control anesthesia system based on this relationship that we developed, the dose of analgesic is adjusted with the necessary remifentanil concentration, determined with propofol-remifentanil interactions, as an estimated maximal individual concentration (esMIC). With the system, a study in patients under anesthesia management by an anesthesiologist was conducted to compare the effect-site concentration (ESC) of remifentanil administered at the anesthesiologist’s discretion and the esMIC calculated with drug-drug interactions for their relationship and to assess whether the analgesic dose administered based on esMIC is appropriate. Methods In the present study involving 20 patients, anesthesiologists changed the propofol (P) infusion rate and remifentanil (R) infusion rate to maintain BIS value of 45. The estimated target-effect-site concentration of propofol for maintaining BIS 45 and the ESC of remifentanil (ESC_R) based on the model by Minto et al. were calculated. Moreover, with these data sets, the isodynamic curve of ESC of propofol (ESC_P) for maintaining BIS 45 (Y) and ESC_R (X) was determined to be an equilateral hyperbola (Y = c/(X − a) + b). With the ESC_R at which even raising ESC_R would result in small decreases in ESC_P considered the esMIC, the ESC_R at the point at which the slope of this curve is − 1 (neutral point) and at the point of the curve where the y-component deviation of the asymptote (y = b) is 20% (esMIC20) was calculated every 6 seconds. The ESC_R at the time point of an adequate analgesic state as deemed by the anesthesiologist after anesthesia had been started for 15 minutes was compared with the esMIC20 determined by objective calculations. Results The ESC_R and esMIC20 were 11.9 ± 2.4 and 11.6 ± 2.0 ng/ml, respectively. Moreover, the median ESC_R and esMIC20 in the patients showed a very good correlation (correlation coefficient R² = 0.88, p < 0.01). Conclusions The necessary analgesic concentrations estimated with drug-drug interactions did not contradict those determined at anesthesiologists’ discretion and are considered to assure a reasonable analgesic state.

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confidence: 99%

“…This demands our continued professional scrutiny, especially when measurements for depth of anesthesia are considered as prognostic measures for clinical management‚ or used as guides or endpoints in current clinical trials, or used in the closed-loop control of anesthetic administration. [1][2][3][4][5][6][7][8] Previously, an A-2000 BIS monitor was forensically disassembled and its algorithms, known collectively as the BIS Engine, were retrieved in machine code from the motherboard. 9 An emulator was then developed, which allowed the BIS Engine to be executed on arbitrary EEG data on a desktop computer to produce depth-of-anesthesia scores.…”

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confidence: 99%

Open Reimplementation of the BIS Algorithms for Depth of Anesthesia

Connor

2022

Anesthesia &Amp; Analgesia

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BACKGROUND: BIS (a brand of processed electroencephalogram [EEG] depth-of-anesthesia monitor) scores have become interwoven into clinical anesthesia care and research. Yet, the algorithms used by such monitors remain proprietary. We do not actually know what we are measuring. If we knew, we could better understand the clinical prognostic significance of deviations in the score and make greater research advances in closed-loop control or avoiding postoperative cognitive dysfunction or juvenile neurological injury. In previous work, an A-2000 BIS monitor was forensically disassembled and its algorithms (the BIS Engine) retrieved as machine code. Development of an emulator allowed BIS scores to be calculated from arbitrary EEG data for the first time. We now address the fundamental questions of how these algorithms function and what they represent physiologically. METHODS: EEG data were obtained during induction, maintenance, and emergence from 12 patients receiving customary anesthetic management for orthopedic, general, vascular, and neurosurgical procedures. These data were used to trigger the closely monitored execution of the various parts of the BIS Engine, allowing it to be reimplemented in a high-level language as an algorithm entitled ibis. Ibis was then rewritten for concision and physiological clarity to produce a novel completely clear-box depth-of-anesthesia algorithm titled openibis. RESULTS: The output of the ibis algorithm is functionally indistinguishable from the native BIS A-2000, with r = 0.9970 (0.9970-0.9971) and Bland-Altman mean difference between methods of -0.25 ± 2.6 on a unitless 0 to 100 depth-of-anesthesia scale. This precision exceeds the performance of any earlier attempt to reimplement the function of the BIS algorithms. The openibis algorithm also matches the output of the native algorithm very closely (r = 0.9395 [0.9390-0.9400], Bland-Altman 2.62 ± 12.0) in only 64 lines of readable code whose function can be unambiguously related to observable features in the EEG signal. The operation of the openibis algorithm is described in an intuitive, graphical form. CONCLUSIONS: The openibis algorithm finally provides definitive answers about the BIS: the reliance of the most important signal components on the low-gamma waveband and how these components are weighted against each other. Reverse engineering allows these conclusions to be reached with a clarity and precision that cannot be obtained by other means. These results contradict previous review articles that were believed to be authoritative: the BIS score does not appear to depend on a bispectral index at all. These results put clinical anesthesia research using depth-of-anesthesia scores on a firm footing by elucidating their physiological basis and enabling comparison to other animal models for mechanistic research.

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Safety and efficacy of an automated anesthesia delivery system for total intravenous anesthesia with propofol, remifentanil, and rocuronium: a non-inferiority randomized controlled trial versus manually controlled anesthesia

Cited by 10 publications

References 6 publications

[Retracted] Application of Intravenous Anesthesia in Laparoscopic Hiatal Hernia Repair of Children

[Retracted] Application of Intravenous Anesthesia in Laparoscopic Hiatal Hernia Repair of Children

Good correlation between necessary remifentanil concentrations in individual patients determined from sedative-analgesic interactions using pharmacokinetic simulations and the remifentanil concentrations used at anesthesiologists’ discretion

Open Reimplementation of the BIS Algorithms for Depth of Anesthesia

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