title: Evaluation of closed-loop anesthesia delivery for propofol anesthesia in pediatric cardiac surgery.
abstract: OBJECTIVE
  The objective of this study was to compare the feasibility of closed-loop anesthesia delivery with manual control of propofol in pediatric patients during cardiac surgery.
  
  
  METHODS
  Forty ASA II-III children, undergoing elective cardiac surgery under cardiopulmonary bypass (CPB) in a tertiary care hospital, were randomized to receive propofol either through a closed-loop anesthesia delivery system (CL group) or through traditional manual control (manual group) to achieve a target BIS of 50. Patients were induced and subsequently maintained with a propofol infusion. The propofol usage and the efficacy of closed-loop system in controlling BIS within ±10 of the target were compared with that of manual control.
  
  
  RESULTS
  The maintenance of BIS within ±10 of target and intraoperative hemodynamic stability were similar between the two groups. However, induction dose of propofol was less in the CL group (2.06 ± 0.79 mg·kg(-1) ) than the manual group (2.95 ± 1.03 mg·kg(-1) ) (P = 0.006) with less overshoot of BIS during induction in the closed-loop group (P = 0.007). Total propofol used in the off-CPB period was less in the CL group (6.29 ± 2.48 mg·kg(-1) h(-1) vs 7.82 ± 2.1 mg·kg(-1) h(-1) ) (P = 0.037). Phenylephrine use in the pre-CPB period was more in the manual group (16.92 ± 10.92 μg·kg(-1) vs 5.79 ± 5.98 μg·kg(-1) ) (P = 0.014). Manual group required a median of 18 (range 8-29) dose adjustments per hour, while the CL group required none.
  
  
  CONCLUSIONS
  This study demonstrated the feasibility of closed-loop controlled propofol anesthesia in children, even in challenging procedures such as cardiac surgery. Closed-loop system needs further and larger evaluation to establish its safety and efficacy.
authors.affiliation: Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Indranil
authors.initials: I
authors.lastname: Biswas
authors.forename: Preethy J
authors.initials: PJ
authors.lastname: Mathew
authors.forename: Rana S
authors.initials: RS
authors.lastname: Singh
authors.forename: Goverdhan D
authors.initials: GD
authors.lastname: Puri
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000764:Anesthesia, Closed-Circuit / Q000379:methods*; D018686:Anesthetics, Intravenous; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D056805:Consciousness Monitors; D003422:Critical Care; D004569:Electroencephalography; D005240:Feasibility Studies; D005260:Female; D005283:Fentanyl; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D010656:Phenylephrine; D015742:Propofol; D012121:Respiration, Artificial; D014662:Vasoconstrictor Agents
chemical_list: D018686:Anesthetics, Intravenous; D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D005283:Fentanyl; D015742:Propofol
keywords: BIS; cardiac surgery; closed-loop anesthesia; propofol; pediatric