Effect of ketamine on the NeuroSENSE WAVCNS during propofol anesthesia; a randomized feasibility trial.
Dose-dependent effects of ketamine on processed electroencephalographic depth-of-hypnosis indices have been reported. Limited data are available for the NeuroSENSE WAVCNS index. Our aim was to establish the feasibility of closed-loop propofol-remifentanil anesthesia guided by the WAVCNS index in the...
| Publicado en: | Journal of Clinical Monitoring & Computing Vol. 35; no. 3; pp. 557 - 568 |
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| Autores principales: | , , , , , , , |
| Formato: | research randomized controlled trial Journal Article |
| Publicado: |
Springer Nature
May2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=150064750&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 150064750 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 13871307 OHC jtl: Journal of Clinical Monitoring & Computing issn: 13871307 maglogo: N pubinfo: dt: May2021 vid: 35 iid: 3 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 150064750 143927613 150064750 NLM32307624 150064750 10.1007/s10877-020-00511-0 NLM32307624 150064750 ppf: 557 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Effect of ketamine on the NeuroSENSE WAVCNS during propofol anesthesia; a randomized feasibility trial. aug: au: van Heusden, Klaske Cooke, Erin Brodie, Sonia West, Nicholas Görges, Matthias Dumont, Guy A Ansermino, J Mark Merchant, Richard N affil: Department of Electrical and Computer Engineering, UBC, Vancouver, BC, Canada sug: subj: Ketamine Propofol Pilot Studies Human Anesthesia, General Anesthetics, Intravenous Adult Comparative Studies Multicenter Studies Randomized Controlled Trials Evaluation Research Validation Studies Funding Source Adult: 19-44 years ab: Dose-dependent effects of ketamine on processed electroencephalographic depth-of-hypnosis indices have been reported. Limited data are available for the NeuroSENSE WAVCNS index. Our aim was to establish the feasibility of closed-loop propofol-remifentanil anesthesia guided by the WAVCNS index in the presence of an analgesic dose of ketamine. Thirty ASA I-II adults, 18-54 years, requiring general anesthesia for anterior cruciate ligament surgery were randomized to receive: full-dose [ketamine, 0.5 mg kg-1 initial bolus, 10 mcg kg-1 min-1 infusion] (recommended dose for postoperative pain management); half-dose [ketamine, 0.25 mg kg-1 bolus, 5 mcg kg-1 min-1 infusion]; or control [no ketamine]. After the ketamine bolus, patients received 1.0 mcg kg-1 remifentanil over 30 s, then 1.5 mg kg-1 propofol over 30 s, followed by manually-adjusted propofol-remifentanil anesthesia. The WAVCNS was > 60 for 7/9 patients in the full-dose group at 7 min after starting the propofol infusion. This was inconsistent with clinical observations of depth-of-hypnosis and significantly higher than control (median difference [MD] 17.0, 95% confidence interval [CI] 11.4-26.8). WAVCNS was median [interquartile range] 49.3 [42.2-62.6] in the half-dose group, and not different to control (MD 5.1, 95% CI - 4.9 to 17.9). During maintenance of anesthesia, the WAVCNS was higher in the full-dose group compared to control (MD 14.7, 95% CI 10.2-19.2) and in the half-dose group compared to control (MD 11.4, 95% CI 4.7-20.4). The full-dose of ketamine recommended for postoperative pain management had a significant effect on the WAVCNS. This effect should be considered when using the WAVCNS to guide propofol-remifentanil dosing.Trial Registration ClinicalTrails.gov No. NCT02908945. pubtype: Academic Journal doctype: research randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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