Narcotrend monitoring allows faster emergence and a reduction of drug consumption in propofol-remifentanil anesthesia.
BACKGROUND
The Narcotrend is a new electroencephalographic monitor designed to measure depth of anesthesia, based on a six-letter classification from A (awake) to F (increasing burst suppression) including 14 substages. This study was designed to investigate the impact of Narcotrend monitoring on recovery times and propofol consumption in comparison to Bispectral Index (BIS) monitoring or standard anesthetic practice.


METHODS
With institutional review board approval and written informed consent, 120 adult patients scheduled to undergo minor orthopedic surgery were randomized to receive a propofol-remifentanil anesthetic controlled by Narcotrend, by BIS(R), or solely by clinical parameters. Anesthesia was induced with 0.4 micro x kg-1 x min-1 remifentanil and a propofol target-controlled infusion at 3.5 microg/ml. After intubation, remifentanil was reduced to 0.2 micro x kg-1 x min-1, whereas the propofol infusion was adjusted according to clinical parameters or to the following target values: during maintenance to D(0) (Narcotrend) or 50 (BIS); 15 min before the end of surgery to C(1) (Narcotrend) or 60 (BIS). Recovery times were recorded by a blinded investigator, and average normalized propofol consumption was calculated from induction and maintenance doses.


RESULTS
The groups were comparable for demographic data, duration of anesthesia, and mean remifentanil dosages. Compared with standard practice, patients with Narcotrend or BIS monitoring needed significantly less propofol (standard practice, 6.8 +/- 1.2 mg x kg-1 x h-1 vs. Narcotrend, 4.5 +/- 1.1 mg x kg-1 x h-1 or BIS(R), 4.8 +/- 1.0 mg x kg-1 x h-1; P < 0.001), opened their eyes earlier (9.3 +/- 5.2 vs. 3.4 +/- 2.2 or 3.5 +/- 2.9 min), and were extubated sooner (9.7 +/- 5.3 vs. 3.7 +/- 2.2 or 4.1 +/- 2.9 min).


CONCLUSIONS
The results indicate that Narcotrend and BIS monitoring are equally effective to facilitate a significant reduction of recovery times and propofol consumption when used for guidance of propofol titration during a propofol-remifentanil anesthetic.
Kreuer
Sascha
S
Department of Anesthesiology and Intensive Care Medicine, University of Saarland, Homburg/Saar, Germany.
Biedler
Andreas
A
Larsen
Reinhard
R
Altmann
Simone
S
Wilhelm
Wolfram
W
D000328:Adult; D000368:Aged; D000465:Algorithms; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous / Q000191:economics; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000191:economics; D004569:Electroencephalography / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000191:economics / Q000379:methods*; D010880:Piperidines / Q000008:administration & dosage / Q000191:economics; D015742:Propofol / Q000008:administration & dosage / Q000191:economics; D000077208:Remifentanil; D012727:Sex Characteristics; D016019:Survival Analysis
D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol