التفاصيل البيبلوغرافية
| العنوان: |
Robust closed-loop control of induction and maintenance of propofol anesthesia in children. |
| المؤلفون: |
West, Nicholas, Dumont, Guy A., Heusden, Klaske, Petersen, Christian L., Khosravi, Sara, Soltesz, Kristian, Umedaly, Aryannah, Reimer, Eleanor, Ansermino, J. Mark, Davidson, Andrew |
| المصدر: |
Pediatric Anesthesia; Aug2013, Vol. 23 Issue 8, p712-719, 8p |
| مصطلحات موضوعية: |
CLOSED loop systems, PROPOFOL, PEDIATRIC anesthesia, ENDOSCOPY, CATHETERS, PHARMACOKINETICS, PHARMACODYNAMICS |
| مستخلص: |
Background During closed-loop control, a drug infusion is continually adjusted according to a measure of clinical effect (e.g., an electroencephalographic depth of hypnosis ( Do H) index). Inconsistency in population-derived pediatric pharmacokinetic/pharmacodynamic models and the large interpatient variability observed in children suggest a role for closed-loop control in optimizing the administration of intravenous anesthesia. Objective To clinically evaluate a robustly tuned system for closed-loop control of the induction and maintenance of propofol anesthesia in children undergoing gastrointestinal endoscopy. Methods One hundred and eight children, aged 6-17, ASA I- II, were enrolled. Prior to induction of anesthesia, Neuro SENSE™ sensors were applied to obtain the WAVCNS Do H index. An intravenous cannula was inserted and lidocaine (0.5 mg·kg−1) administered. Remifentanil was administered as a bolus (0.5 μg·kg−1), followed by continuous infusion (0.03 μg·kg−1·min−1). The propofol infusion was closed-loop controlled throughout induction and maintenance of anesthesia, using WAVCNS as feedback. Results Anesthesia was closed-loop controlled in 102 cases. The system achieved and maintained an adequate Do H without manual adjustment in 87/102 (85%) cases. Induction of anesthesia (to WAVCNS ≤ 60) was completed in median 3.8 min (interquartile range ( IQR) 3.1-5.0), culminating in a propofol effect-site concentration ( Ce) of median 3.5 μg·ml−1 ( IQR 2.7-4.5). During maintenance of anesthesia, WAVCNS was measured within 10 units of the target for median 89% ( IQR 79-96) of the time. Spontaneous breathing required no manual intervention in 91/102 (89%) cases. Conclusions A robust closed-loop system can provide effective propofol administration during induction and maintenance of anesthesia in children. Wide variation in the calculated Ce highlights the limitation of open-loop regimes based on pharmacokinetic/pharmacodynamic models. [ABSTRACT FROM AUTHOR] |
|
Copyright of Pediatric Anesthesia is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| قاعدة البيانات: |
Complementary Index |
