The impact of Narcotrend™ <scp>EEG</scp>‐guided propofol administration on the speed of recovery from pediatric procedural sedation—A randomized controlled trial

Weber, Frank; Walhout, Laurence C.; Escher, Johanna C.

doi:10.1111/pan.13365

Cited by 23 publications

(16 citation statements)

References 25 publications

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“…18–21 Seven randomized controlled trials investigated EEG-guidance during anesthesia, 11,25,30 several of which demonstrated benefit. 11,27–29 Eight observational studies 9,10,31–35 demonstrated usefulness of EEG-guided anesthesia in children, and 32 observational studies described anesthesia-induced changes in children’s brains. 37–68 (Supplemental Digital Content 2, Table, http://links.lww.com/AA/E82, provides a summary and key findings of the 59 papers that underwent full-text review.)…”

mentioning

confidence: 99%

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Bong

Balanza

Khoo

et al. 2022

Anesthesia &Amp; Analgesia

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The major therapeutic end points of general anesthesia include hypnosis, amnesia, and immobility. There is a complex relationship between general anesthesia, responsiveness, hemodynamic stability, and reaction to noxious stimuli. This complexity is compounded in pediatric anesthesia, where clinicians manage children from a wide range of ages, developmental stages, and body sizes, with their concomitant differences in physiology and pharmacology. This renders anesthetic requirements difficult to predict based solely on a child’s age, body weight, and vital signs. Electroencephalogram (EEG) monitoring provides a window into children’s brain states and may be useful in guiding clinical anesthesia management. However, many clinicians are unfamiliar with EEG monitoring in children. Young children’s EEGs differ substantially from those of older children and adults, and there is a lack of evidence-based guidance on how and when to use the EEG for anesthesia care in children. This narrative review begins by summarizing what is known about EEG monitoring in pediatric anesthesia care. A key knowledge gap in the literature relates to a lack of practical information illustrating the utility of the EEG in clinical management. To address this gap, this narrative review illustrates how the EEG spectrogram can be used to visualize, in real time, brain responses to anesthetic drugs in relation to hemodynamic stability, surgical stimulation, and other interventions such as cardiopulmonary bypass. This review discusses anesthetic management principles in a variety of clinical scenarios, including infants, children with altered conscious levels, children with atypical neurodevelopment, children with hemodynamic instability, children undergoing total intravenous anesthesia, and those undergoing cardiopulmonary bypass. Each scenario is accompanied by practical illustrations of how the EEG can be visualized to help titrate anesthetic dosage to avoid undersedation or oversedation when patients experience hypotension or other physiological challenges, when surgical stimulation increases, and when a child’s anesthetic requirements are otherwise less predictable. Overall, this review illustrates how well-established clinical management principles in children can be significantly complemented by the addition of EEG monitoring, thus enabling personalized anesthesia care to enhance patient safety and experience.

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mentioning

confidence: 99%

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Bong

Balanza

Khoo

et al. 2022

Anesthesia &Amp; Analgesia

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“…9,20 Weber et al showed lower consumption of anaesthetic agents and faster awakening after the procedure in randomized controlled trial with Narcotrend in children's anaesthesia for endoscopic procedures. 21 Another device worth applying is SedLine monitor, which is based on 4-channel EEG, separately monitoring both hemispheres. Apart from the global patient state index (PSI), whose reference value during administering general anaesthesia should be between 25 and 50, the analysis encompasses also the spectral density of EEG wave from over both hemispheres.…”

Section: Resultsmentioning

confidence: 99%

Asleep or awake? That is the question… A review of techniques available for monitoring the depth of anaesthesia

et al. 2020

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Introduction: The problem of intraoperative awareness concerns about 0.1%–0.2% of patients .The perfect method to evaluate the depth of sleep should be objective, so that the response is quick and precise – to increase or decrease the depth of anaesthesia. More scales originated in order to detect cases of intraoperative awareness. Also, new equipment was built so that anaesthesiologists could properly monitor the depth of anaesthesia. Aim: The aim is to describe methods and devices monitoring the depth of anaesthesia. Material and methods: This work was based on the available literature and the experience of the authors. Results and discussion: Recently a few devices were constructed, all of which can be divided into passive and active systems. Passive systems assess the collected data, while active ones first stimulate and then receive and process data. Passive systems use computer analysis of electroencephalographic signal, and some of them additionally evaluate alterations of frontal electromyogram. According to some, monitors currently available on the market show around 80% effectiveness in preventing intraoperative awareness. Other researchers showed that evidence of their effect on intraoperative awareness is limited. Conclusions: It seems that when it comes to the effect of anaesthetic agents on such a precise organ as the brain, there is still much to discover. As long as we do not fully know what awareness is and what mechanisms influence the state of staying awake and of anaesthetic sleep, and on which levels it happens, we will not be able to prevent intraoperative awareness effectively.

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“…Currently, there are evidences supporting the value of Narcotrend in titrating drug dosages both in the adult and paediatric population in the operating room and the non-operating room setting 39–44…”

Section: Discussionmentioning

confidence: 99%

Narcotrend-guided intraoperative care of a Trisomy 21 paediatric patient who underwent occipitocervical fusion

Villa

Bundoc

2020

BMJ Case Rep

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A 9-year-old female with Trisomy 21 with complex craniovertebral instability causing severe cervicomedullary compression underwent occipitocervical fusion. This paper will discuss the anaesthetic management and highlight the use of the Narcotrend monitor not only as a depth of consciousness monitor but more importantly as a tool to detect surgery-induced cerebral hypoperfusion by monitoring the right and left cerebral hemispheres independently and simultaneously.

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The impact of Narcotrend™ EEG‐guided propofol administration on the speed of recovery from pediatric procedural sedation—A randomized controlled trial

Cited by 23 publications

References 25 publications

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

Asleep or awake? That is the question… A review of techniques available for monitoring the depth of anaesthesia

Narcotrend-guided intraoperative care of a Trisomy 21 paediatric patient who underwent occipitocervical fusion

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