title: Titration of sevoflurane in elderly patients: blinded, randomized clinical trial, in non-cardiac surgery after beta-adrenergic blockade.
abstract: BACKGROUND
  Monitoring depth of anesthesia via the processed electroencephalogram (EEG) has been found useful in reducing the amount of anesthetic drugs, optimizing wake-up times, and, in some studies, reducing awareness. Our goal was to determine if titrating sevoflurane as the maintenance anesthetic to a depth of anesthesia monitor (SEDLine™, Masimo, CA) would shorten time to extubation in elderly patients undergoing non-cardiac surgery while on beta-adrenergic blockade. This patient population was selected because the usual cardiovascular signs of inadequate general anesthesia may be masked by beta-blocker therapy.
  
  
  METHODS
  Surgical patients older than 65 years of age receiving beta-adrenergic blockers for a minimum of 24 h preoperatively were randomized to two groups: a group whose titration of sevoflurane was based on SEDLine™ data (SEDLine™ group) and a group whose titration was based on usual clinical criteria (control group) where SEDLine™ data were concealed. The primary endpoint was time from skin closure to time to extubation. Aldrete score, White Fast Track score and QoR-40 were also assessed.
  
  
  RESULTS
  There was no significant difference in time to extubation [12.5 (SD 7.4) min in the control group versus 13.0 (SD 5.9) min for the treatment group]. The control group used more fentanyl [339 mcg (SD 205)] than did the treatment group [238 mcg (SD 123)] (P<0.02). There was no difference in sevoflurane utilization, Aldrete, White Fast Track scores, time to PACU discharge, or QoR-40 assessments between the groups.
  
  
  CONCLUSIONS
  Use of the SEDLine™ monitor's data to titrate sevoflurane did not improve the time to extubation or change short-term outcome of geriatric surgical patients receiving beta-adrenergic blockers. (ClinicalTrials.gov number, NCT00938782).
authors.affiliation: Department of Anesthesia, Stanford University, CA 94305-5640, USA. ddrover@stanford.edu
authors.forename: David R
authors.initials: DR
authors.lastname: Drover
authors.forename: Clifford
authors.initials: C
authors.lastname: Schmiesing
authors.forename: Anthea F
authors.initials: AF
authors.lastname: Buchin
authors.forename: H Rick
authors.initials: HR
authors.lastname: Ortega
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Tanner
authors.forename: Joshua H
authors.initials: JH
authors.lastname: Atkins
authors.forename: Alex
authors.initials: A
authors.lastname: Macario
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D016343:Monitoring, Intraoperative; D000077149:Sevoflurane; D016037:Single-Blind Method; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane