title: Closed loop anaesthesia at high altitude (3505 m above sea level): Performance characteristics of an indigenously developed closed loop anaesthesia delivery system.
abstract: BACKGROUND
  Closed loop anaesthesia delivery systems (CLADSs) are a recent advancement in accurate titration of anaesthetic drugs. They have been shown to be superior in maintaining adequate depth of anaesthesia with few fluctuations as compared with target-controlled infusion or manual titration of drug delivery.
  
  
  METHODS
  Twenty patients scheduled to undergo general abdominal or orthopaedic procedures under general anaesthesia at Leh (3505 m above sea level) were recruited as subjects. Anaesthesia was delivered by a patented closed loop system that uses the Bispectral Index (BIS™) as a feedback parameter to titrate the rate of propofol infusion. All vital parameters, drug infusion rate and the BIS™ values were continuously recorded and stored online by the system. The data generated was analysed for the adequacy of anaesthetic depth, haemodynamic stability and post-operative recovery parameters.
  
  
  RESULTS
  The CLADS was able to maintain a BIS™ within ±10 of the target of 50 for 85.0±7.8% of the time. Haemodynamics were appropriately maintained (heart rate and mean arterial blood pressure were within 25% of baseline values for 91.2±2.2% and 94.1±3% of the total anaesthesia time, respectively). Subjects were awake within a median of 3 min from cessation of drug infusion and achieved fitness to recovery room discharge within a median of 15 min. There were no adverse events or report of awareness under anaesthesia.
  
  
  CONCLUSIONS
  The study demonstrates the safety of our CLADS at high altitude. It seeks to extend the use of our system in challenging anaesthesia environments. The system performance was also adequate and no adverse events were recorded.
authors.affiliation: Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India.
authors.forename: Goverdhan D
authors.initials: GD
authors.lastname: Puri
authors.forename: Aveek
authors.initials: A
authors.lastname: Jayant
authors.forename: Morup
authors.initials: M
authors.lastname: Tsering
authors.forename: Motup
authors.initials: M
authors.lastname: Dorje
authors.forename: Motup
authors.initials: M
authors.lastname: Tashi