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Impact of the Narcotrend Index on propofol consumption and emergence times during total intravenous anaesthesia with propofol and remifentanil in children: a clinical utility study

Published online by Cambridge University Press:  15 September 2005

F. Weber ,
F. Pohl ,
H. Hollnberger  and
K. Taeger
F. Weber
Affiliation:
University of Regensburg, Department of Anaesthesia, Regensburg, Germany
F. Pohl
Affiliation:
Children's Hospital St. Hedwig, Department of Anaesthesia, Regensburg, Germany
H. Hollnberger
Affiliation:
Children's Hospital St. Hedwig, Department of Anaesthesia, Regensburg, Germany
K. Taeger
Affiliation:
University of Regensburg, Department of Anaesthesia, Regensburg, Germany
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Extract

Summary

Background and objective: The electroencephalographic Narcotrend Index (NI) is a measure of the hypnotic component of general anaesthesia. The purpose of this study was to evaluate the impact of Narcotrend guidance on propofol consumption and emergence times in children receiving total intravenous anaesthesia with propofol and remifentanil. Methods: Thirty children, aged 1–11 yr, scheduled for paediatric urological surgery were enrolled. Remifentanil was given to all patients at a constant infusion rate of 0.3 μg kg−1 min−1 throughout anaesthesia. Patients were randomly allocated to receive a continuous propofol infusion adjusted either according to a conventional clinical practice (Group C: n = 15) or guided by Narcotrend monitoring (Group NI: n = 15; target NI 60 ± 5). All patients were connected to the Narcotrend Monitor, but in Group C the anaesthetist was blinded to the screen of the monitor. Propofol consumption (mg kg−1 h−1) and emergence times (min) were the primary and secondary outcome measures. Results: Propofol consumption (median [inter-quartile range]) was significantly lower in Group NI compared to Group C (NI: 7.0 [6.4–8.2] vs. C: 9.3 [8.3–11.0] mg kg−1 h−1; P < 0.001), whereas Log-Rank-analysis revealed no intergroup difference in emergence times (Group NI: mean [95% confidence interval (CI)] 12.8 [11.2–14.4] min; Group C: 16.4 [12.6–20.2] min; P = 0.10). Haemodynamic variables remained stable within age-related limits, and there were no observations of adverse events, especially no clinical signs of intraoperative awareness in any patient. Conclusion: Narcotrend monitoring for guidance of propofol/remifentanil anaesthesia in children results in reduced propofol consumption compared to a conventional clinical practice.

Keywords

ANAESTHESIA GENERALELECTRODIAGNOSIS, electroencephalographyHYPNOSIS, anaestheticSURGICAL PROCEDURES OPERATIVE, monitoring intraoperativeCHILD, PRESCHOOLCHILD
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 10 , October 2005 , pp. 741 - 747
Copyright
© 2005 European Society of Anaesthesiology

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References

Kreuer S, Biedler A, Larsen R et al. Narcotrend monitoring allows faster emergence and a reduction of drug consumption in propofol–remifentanil anesthesia. Anesthesiology 2003; 99: 34–41.Google Scholar
Malviya S, Voepel-Lewis T, Tait AR et al. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth 2002; 88: 241–245.Google Scholar
Schultz B, Kreuer S, Wilhelm W et al. The Narcotrend Monitor: development and interpretation algorithms [in German]. Anaesthesist 2003; 52: 1143–1148.Google Scholar
Schultz B, Grouven U, Schultz A. Automatic classification algorithms of the EEG monitor Narcotrend for routinely recorded EEG data from general anaesthesia: a validation study. Biomed Tech 2002; 47: 9–13.Google Scholar
Struys MM, Jensen EW, Smith W et al. Performance of the ARX-derived auditory evoked potential index as an indicator of anesthetic depth: a comparison with bispectral index and hemodynamic measures during propofol administration. Anesthesiology 2002; 96: 803–816.Google Scholar
Denman WT, Swanson EL, Rosow D et al. Pediatric evaluation of the bispectral index (BIS) monitor and correlation of BIS with end-tidal sevoflurane concentration in infants and children. Anesth Analg 2000; 90: 872–877.Google Scholar
McCann ME, Bacsik J, Davidson A et al. The correlation of bispectral index with endtidal sevoflurane concentration and haemodynamic parameters in preschoolers. Paediatr Anaesth 2002; 12: 519–525.Google Scholar
Recart A, White PF, Wang A et al. Effect of auditory evoked potential index monitoring on anesthetic drug requirements and recovery profile after laparoscopic surgery: a clinical utility study. Anesthesiology 2003; 99: 813–818.Google Scholar
White PF, Ma H, Tang J et al. Does the use of electroencephalographic bispectral index or auditory evoked potential index monitoring facilitate recovery after desflurane anesthesia in the ambulatory setting? Anesthesiology 2004; 100: 811–817.Google Scholar
Weber F, Seidl M, Bein T. Impact of the AEP-Monitor/2-derived composite auditory-evoked potential index on propofol consumption and emergence times during total intravenous anaesthesia with propofol and remifentanil in children. Acta Anaesthesiol Scand 2005; 49: 277–283.Google Scholar