A beat-by-beat cardiovascular index, CARDEAN: a prospective randomized assessment of its utility for the reduction of movement during colonoscopy.
BACKGROUND
We sought to determine whether online use of a beat-by-beat cardiovascular index, CARDEAN (Alpha-2, Lyon, France), modifies the incidence of patient movement during colonoscopy under anesthesia.


METHODS
Monitoring included an electrocardiogram, oscillometric and noninvasive beat-by-beat arterial blood pressure, O2 saturation, bispectral index (BIS), and CARDEAN. CARDEAN consists of beat-by-beat Finapres (Ohmeda, Madison, WI) combined with an algorithm that detects hypertension followed by tachycardia and produces an index scaled 0 to 100. The anesthesiologist was denied access to Finapres and CARDEAN. Propofol was adjusted to keep 40<BIS<60. Alfentanil 3.5 microg x kg(-1) was administered according to conventional signs (tachycardia, hypertension, and movement), unless the patient had signs of brady/apnea or Spo(2) <95%. One hundred fifty-nine patients presenting for colonoscopy under propofol anesthesia were prospectively randomized to (i) control: no other intervention, or (ii) CARDEAN: in addition to conventional signs, an observer instructed the anesthesiologist to administer alfentanil when CARDEAN was >60. The primary outcome was the number of observed movements.


RESULTS
Data were analyzed in 146 patients (control: 75; CARDEAN: 71). The doses of propofol and alfentanil were similar in both groups. When BIS was <60, movements were less frequent in the CARDEAN group (3.3 movements/100 min [2.3-4.8]) than in the control group (6.7 [5.3-8.5]) (odds ratio: 0.5 [0.32; 0.76], P = 0.001). During the first 10 minutes of the procedure, the incidence of movements was 38% and 59% in the CARDEAN and control groups, respectively (P = 0.04).


CONCLUSIONS
With BIS <60, CARDEAN-guided opioid administration is associated with a reduction of 51% of clinically unpredictable movements in unparalyzed patients undergoing colonoscopy. More studies are required to refine the role of CARDEAN in surgical settings.
Martinez
Jean Yves
JY
Department of Anesthesiology/Critical Care Medicine, Hôpital d'Instruction des Armées Desgenettes, Lyon-Villeurbanne, France.
Wey
Pierre François
PF
Lions
Christophe
C
Cividjian
Andrei
A
Rabilloud
Muriel
M
Bissery
Alvine
A
Bourdon
Lionel
L
Puidupin
Marc
M
Escarment
Jacques
J
Quintin
Luc
L
D000328:Adult; D015760:Alfentanil / Q000008:administration & dosage* / Q000009:adverse effects; D000465:Algorithms; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure; D001795:Blood Pressure Determination; D003113:Colonoscopy; D056805:Consciousness Monitors; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods; D009068:Movement / Q000187:drug effects*; D009991:Oscillometry; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D011237:Predictive Value of Tests; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012985:Software Design; D013610:Tachycardia / Q000139:chemically induced
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D015760:Alfentanil; D010100:Oxygen; D015742:Propofol