title: Navigator® and SmartPilot® View are helpful in guiding anesthesia and reducing anesthetic drug dosing.
abstract: BACKGROUND
  The recently introduced Navigator® (GE Healthcare, Helsinki, Finland) and SmartPilot® View (Dräger Medical, Lübeck, Germany) show the concentrations and predicted effects of combined anesthetic drugs, and should facilitate more precisely their titration. Our aim was to evaluate if Navigator® or SmartPilot® View guided anesthesia was associated with a good quality of analgesia, depth of hypnosis and may reduce anesthetic requirements.
  
  
  METHODS
  We performed a prospective non-randomized study. Sixty ASA I-II patients undergoing balanced general anesthesia for abdominal and plastic surgery were enrolled. Patients were divided in 4 groups. Group 1 (N. 15) and group 3 (N. 15) were cases in whom anesthesia was performed with standard monitoring plus the aid of Navigator® (Nav) or SmartPilot® View (SPV) display. Group 2 (N. 15) and group 4 (N. 15) were controls in whom anesthesia was performed with standard monitoring (heart rate, NIBP, SpO2, end-tidal CO2, end-expired sevoflurane concentration, train of four, Bispectral Index [Aspect Medical Systems, Natick, MA, USA] or Entropy [GE Healthcare]). Patients' vital parameters and end-expired sevoflurane concentration were recorded during anesthesia.
  
  
  RESULTS
  All patients recovered uneventfully and showed hemodynamic stability. End-tidal sevoflurane concentrations values [median (min-max)], during maintenance of anesthesia, were significantly (P<0.05) lower in SPV [1.1% (0.8-1.5)] and Nav [1%(0.8-1.8)] groups compared to SPV-control group [1.5%(1-2.5)] and Nav-control group [1.5%(0.8-2)]. BIS and entropy values were respectively higher in the SPV group [53 (46-57)] compared to the control group [43 (37-51)] (P<0.05) and Nav group [53 (43-60)] compared to the control group [41 (35-51)] (P<0.05). No significant differences in Remifentanil dosing were observed in the four groups.
  
  
  CONCLUSIONS
  Navigator® and SmartPilot® View may be of clinical use in monitoring adequacy of anesthesia. Both displays can optimize the administration and monitoring of anesthetic drugs during general anesthesia and may reduce the consumption of volatile anesthetic agents.
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University Federico II, Naples, Italy - ederober@unina.it.
authors.forename: V
authors.initials: V
authors.lastname: Cirillo
authors.forename: G
authors.initials: G
authors.lastname: Zito Marinosci
authors.forename: E
authors.initials: E
authors.lastname: De Robertis
authors.forename: C
authors.initials: C
authors.lastname: Iacono
authors.forename: G M
authors.initials: GM
authors.lastname: Romano
authors.forename: O
authors.initials: O
authors.lastname: Desantis
authors.forename: O
authors.initials: O
authors.lastname: Piazza
authors.forename: G
authors.initials: G
authors.lastname: Servillo
authors.forename: R
authors.initials: R
authors.lastname: Tufano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D000776:Anesthesiology / Q000295:instrumentation*; D000777:Anesthetics / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000493:pharmacokinetics; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000493:pharmacokinetics; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010880:Piperidines / Q000008:administration & dosage / Q000493:pharmacokinetics; D011446:Prospective Studies; D000077208:Remifentanil; D000077149:Sevoflurane; D055815:Young Adult
chemical_list: D000777:Anesthetics; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil