title: Feasibility of closed-loop titration of propofol guided by the Bispectral Index for general anaesthesia induction: a prospective randomized study.
abstract: BACKGROUND
  This study was designed to evaluate the feasibility of propofol infusion by a closed-loop system for the titration of anaesthetic induction guided by Bispectral Index.
  
  
  METHODS
  Forty patients were prospectively and randomly allocated into two groups: the target control infusion (TCI) group, where propofol titration was performed manually guided by the Bispectral Index using a commercial pharmacokinetic model (Diprifusor device) and the closed-loop group where titration was performed using a proportional differential algorithm. For both groups, the objective was to achieve a Bispectral Index of 50. Remifentanil TCI was infused at a target of 2 ng mL-1 and was maintained constant throughout the study. Feasibility of automatic induction was evaluated with performance error and haemodynamic data.
  
  
  RESULTS
  Bispectral Index overshoot (-9 +/- 13% vs. -16 +/- 20%, P = 0.035) and mean duration of induction (381 +/- 106 s vs. 490 +/- 131 s, P = 0.004) were lower in the closed-loop group than in the TCI group. Haemodynamic data were similar between groups with a similar use of ephedrine bolus.
  
  
  CONCLUSIONS
  The system was able to allow induction clinically for all patients. Automated titration guided by Bispectral Index for propofol infusion was feasible without increase in haemodynamic adverse effects.
authors: Department of Anaesthesiology, Hôpital Foch, Suresnes, France.
authors: N
authors: N
authors: Liu
authors: T
authors: T
authors: Chazot
authors: B
authors: B
authors: Trillat
authors: R
authors: R
authors: Pirracchio
authors: J-D
authors: JD
authors: Law-Koune
authors: L
authors: L
authors: Barvais
authors: M
authors: M
authors: Fischler