title: Effects of indexes of consciousness (IoC1 and IoC2) monitoring on remifentanil dosage in modified radical mastectomy: a randomized trial.
abstract: BACKGROUND
  This study investigated the effects of indexes of consciousness (IoC1 and IoC2) monitoring on remifentanil dosage.
  
  
  METHODS
  In this randomized, single-blinded, prospective study, 120 patients undergoing unilateral modified radical mastectomy were randomly assigned to the treatment group (T group, n = 60) or control group (C group, n = 60). In the T group, patients received both IoC1 (sedation) and IoC2 (analgesia) monitoring, and remifentanil dosages were adjusted by anesthetists according to IoC2. In the C group, remifentanil dosages were adjusted based on the anesthetists' judgment according to the patients' vital signs. Remifentanil dose, adjustment frequency, infusion duration, intraoperative adverse events, and quality of anesthetic recovery were compared between the two groups. The primary outcome was the dose of remifentanil.
  
  
  RESULTS
  Compared with the C group, mean remifentanil dosage was significantly higher in the T group (3.8 ± 1.9 versus 3.2 ± 1.2 μg kg(-1) h(-1), P < 0.05) during the anesthetic period, as was the adjustment frequency of target-controlled infusion (2.9 ± 1.9 versus 2.0 ± 1.2 times/surgery, P < 0.05), but there was no difference in infusion duration. Voluntary eye opening, extubation time, and recovery score were not significantly different between the two groups (P > 0.05). Total adverse events were significantly reduced in the T group (P < 0.05).
  
  
  CONCLUSIONS
  IoC1-targeted propofol dosing does not seem to be significantly different to hemodynamic-based monitoring, whereas IoC2 monitoring can increase remifentanil dosage during modified radical mastectomy, but the anesthetic process is more controllable and total adverse events are reduced, which improves the controllability of anesthesia.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  ChiCTR-TRC-13004101 , registered on 27 November 2013.
authors.affiliation: Department of Anesthesiology, Qilu Hospital, Shandong University, Jinan, 250012, China.|Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, 252000, China.
authors.forename: Guisheng
authors.initials: G
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, 252000, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, 252000, China.
authors.forename: Xuxiang
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, 252000, China.
authors.forename: Ailan
authors.initials: A
authors.lastname: Yu
authors.affiliation: Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, 252000, China.
authors.forename: Zongwang
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Qilu Hospital, Shandong University, Jinan, 250012, China. yujingui1109@126.com.
authors.forename: Jingui
authors.initials: J
authors.lastname: Yu
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure; D002681:China; D003243:Consciousness / Q000187:drug effects*; D005260:Female; D006339:Heart Rate; D006801:Humans; D015411:Mastectomy, Modified Radical / Q000009:adverse effects; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D020127:Recovery of Function; D000077208:Remifentanil; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol
keywords: Index of consciousness; IoC2 monitoring; Propofol; Remifentanil; Unilateral modified radical mastectomy