title: Effects of A-line Autoregression Index (AAI) monitoring on recovery after sevoflurane anesthesia for bariatric surgery.
abstract: Monitoring depth of anesthesia may improve anesthetic dosing and postanesthetic recovery in obese patients. Sixty morbidly obese patients undergoing laparoscopic adjustable gastric bandage (LAGB) were randomly assigned to receive anesthesia with sevoflurane titrated by either standard clinical parameters (SCP) (target = baseline hemodynamic parameters ± 20%) or by A-line ARX index (AAI) (target = 20 ± 5). Heart rate, arterial blood pressure, inspiratory and expiratory gas concentrations, and AAI were recorded in all patients at 5-min intervals, but AAI was made available only to the anesthesiologist assigned to AAI-monitored patients. Emergence times in surgery room and recovery times in postanesthesia care unit (PACU) were recorded at 1- and 30-min intervals. Mean intraoperative values of AAI were higher in AAI-monitored than in SCP-monitored patients (22.5 vs 15.0, p = 0.001). Compared to SCP monitoring, AAI monitoring reduced consumption of sevoflurane by 20% (p = 0.014), times to eye opening by 2.4 min (p = 0.001) and to extubation by 2.5 min (p = 0.009) and to achieve SpO(2) 92% in room air by 17 min (p = 0.001). Aldrete scores were higher in AAI- than in SCP-monitored patients at arrival in PACU (p = 0.035), but Aldrete scores ≥ 9 were attained in similar times. AAI monitoring can improve titration of and recovery from sevoflurane for LAGB.
authors.affiliation: Dipartimento di Farmacologia e Anestesiologia, Università di Padova, Via C. Battisti, 267, 35121, Padova, Italy. ulderico.freo@unipd.it
authors.forename: Ulderico
authors.initials: U
authors.lastname: Freo
authors.forename: Michele
authors.initials: M
authors.lastname: Carron
authors.forename: Federico
authors.initials: F
authors.lastname: Innocente
authors.forename: Mirto
authors.initials: M
authors.lastname: Foletto
authors.forename: Donato
authors.initials: D
authors.lastname: Nitti
authors.forename: Carlo
authors.initials: C
authors.lastname: Ori
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D005072:Evoked Potentials, Auditory; D005260:Female; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane
references.citation: Anesth Analg. 1999 Jul;89(1):243-51
references.pmid: 10389813
references.citation: J Clin Anesth. 1995 Feb;7(1):89-91
references.pmid: 7772368
references.citation: Anesth Analg. 1986 Jun;65(6):575-82
references.pmid: 3706798
references.citation: Best Pract Res Clin Anaesthesiol. 2006 Mar;20(1):181-9
references.pmid: 16634424
references.citation: Acta Anaesthesiol Scand. 2005 May;49(5):692-7
references.pmid: 15836686
references.citation: Anesth Analg. 2004 Dec;99(6):1848-1853
references.pmid: 15562085
references.citation: Br J Anaesth. 2003 Nov;91(5):638-50
references.pmid: 14570784
references.citation: Anesth Analg. 2008 Dec;107(6):1864-70
references.pmid: 19020131
references.citation: Anesthesiology. 2007 Jan;106(1):33-42
references.pmid: 17197843
references.citation: Br J Anaesth. 2005 Jan;94(1):63-9
references.pmid: 15516347
references.citation: Anaesthesia. 2001 Sep;56(9):888-93
references.pmid: 11531678
references.citation: Can J Neurol Sci. 2008 Mar;35(1):31-40
references.pmid: 18380275
references.citation: Br J Anaesth. 2003 Oct;91(4):502-6
references.pmid: 14504150
references.citation: Anesth Analg. 1997 Sep;85(3):681-6
references.pmid: 9296431
references.citation: Curr Opin Anaesthesiol. 2004 Feb;17(1):21-30
references.pmid: 17021525
references.citation: Anesthesiology. 2003 Oct;99(4):813-8
references.pmid: 14508311
references.citation: J Neurosurg Anesthesiol. 2009 Jul;21(3):207-13
references.pmid: 19542997
references.citation: Br J Anaesth. 2007 Sep;99(3):353-8
references.pmid: 17621601
references.citation: Anesthesiology. 1999 Nov;91(5):1221-31
references.pmid: 10551570
references.citation: Acta Anaesthesiol Scand. 2002 Aug;46(7):882-6
references.pmid: 12139546
references.citation: Br J Anaesth. 2000 Jul;85(1):91-108
references.pmid: 10927998
references.citation: Anesth Analg. 1999 Jan;88(1):213-9
references.pmid: 9895095
references.citation: Anesthesiology. 2004 Apr;100(4):811-7
references.pmid: 15087615
references.citation: Anesth Analg. 2002 Aug;95(2):362-7, table of contents
references.pmid: 12145052
references.citation: J Clin Anesth. 2007 Feb;19(1):3-8
references.pmid: 17321919
references.citation: Anesth Analg. 2003 Jan;96(1):108-11, table of contents
references.pmid: 12505934
references.citation: Eur J Anaesthesiol. 2010 Jun;27(6):501-7
references.pmid: 19550338
references.citation: Anesth Analg. 2004 Mar;98(3):632-41, table of contents
references.pmid: 14980911
references.citation: J Surg Res. 2010 Apr;159(2):622-6
references.pmid: 20006346
references.citation: J Clin Anesth. 2005 Sep;17(6):413-9
references.pmid: 16171660
references.citation: Anesth Analg. 1999 Jul;89(1):209-14
references.pmid: 10389806
references.citation: J Clin Anesth. 2005 Sep;17(6):411-2
references.pmid: 16171659
references.citation: Anesthesiology. 1995 Jun;82(6):1369-78
references.pmid: 7793651
references.citation: Best Pract Res Clin Anaesthesiol. 2006 Mar;20(1):129-39
references.pmid: 16634420
references.citation: Anesth Analg. 2006 Nov;103(5):1189-95
references.pmid: 17056953
references.citation: CNS Drugs. 2005;19(12):1069-74
references.pmid: 16332149
references.citation: J Clin Anesth. 2005 Mar;17(2):134-45
references.pmid: 15809132
references.citation: Can J Anaesth. 2009 Jun;56(6):449-66
references.pmid: 19399574
references.citation: Acta Anaesthesiol Scand. 2002 May;46(5):495-9
references.pmid: 12027841
references.citation: Anesthesiology. 2009 Nov;111(5):979-87
references.pmid: 19809292
references.citation: Anesth Analg. 1998 Sep;87(3):654-60
references.pmid: 9728848
references.citation: Anesth Analg. 2003 Dec;97(6):1667-1674
references.pmid: 14633540
references.citation: Anesth Analg. 2000 Jan;90(1):168-74
references.pmid: 10624999