Implementation of a Bayesian based advisory tool for target-controlled infusion of propofol using qCON as control variable.

Autor: Vellinga R; Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Introna M; Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.; NeuroAnesthesia and NeuroIntensive Care, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133, Milan, Italy., van Amsterdam K; Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Zhou XYT; Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., De Smet T; Demed Medical, Sinaai, Belgium., Weber Jensen E; Centre for Biomedical Research (CREB), UPC-Barcelonatech, Barcelona, Spain., Struys MMRF; Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.; Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium., van den Berg JP; Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. j.p.van.den.berg@umcg.nl.
Jazyk: angličtina
Zdroj: Journal of clinical monitoring and computing [J Clin Monit Comput] 2024 Apr; Vol. 38 (2), pp. 519-529. Date of Electronic Publication: 2023 Dec 19.
DOI: 10.1007/s10877-023-01106-1
Abstrakt: This single blinded randomized controlled trial aims to assess whether the application of a Bayesian-adjusted Ce PROP (effect-site of propofol) advisory tool leads towards a more stringent control of the cerebral drug effect during anaesthesia, using qCON as control variable. 100 patients scheduled for elective surgery were included and randomized into a control or intervention group (1:1 ratio). In the intervention group the advisory screen was made available to the clinician, whereas it was blinded in the control group. The settings of the target-controlled infusion pumps could be adjusted at any time by the clinician. Cerebral drug effect was quantified using processed EEG (CONOX monitor, Fresenius Kabi, Bad Homburg, Germany). The time of qCON between the desired range (35-55) during anaesthesia maintenance was defined as our primary end point. Induction parameters and recovery times were considered secondary end points and coefficient of variance of qCON and Ce PROP was calculated in order to survey the extent of control towards the mean of the population. The desired range of qCON between 35 and 55 was maintained in 84% vs. 90% (p = 0.15) of the case time in the control versus intervention group, respectively. Secondary endpoints showed similar results in both groups. The coefficient of variation for Ce PROP was higher in the intervention group. The application of the Bayesian-based Ce PROP advisory system in this trial did not result in a different time of qCON between 35 and 55 (84 [21] vs. 90 [18] percent of the case time). Significant differences between groups were hard to establish, most likely due to a very high performance level in the control group. More extensive control efforts were found in the intervention group. We believe that this advisory tool could be a useful educational tool for novices to titrate propofol effect-site concentrations.
(© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)
Databáze: MEDLINE
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