Kuizenga, Merel H; Vereecke, Hugo E M; Absalom, Anthony R; Bucher, Christian H; Hannivoort, Laura N; van den Berg, Johannes P; Schmalz, Livia; Struys, Michel M R F; Luginbühl, Martin (2022). Utility of the SmartPilot® View advisory screen to improve anaesthetic drug titration and postoperative outcomes in clinical practice: a two-centre prospective observational trial. British journal of anaesthesia, 128(6), pp. 959-970. Elsevier 10.1016/j.bja.2022.02.033
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BACKGROUND
The advisory system SmartPilot® View (Drägerwerk AG, Lübeck, Germany) provides real-time, demographically adjusted pharmacodynamic information throughout anaesthesia, including time course of effect-site concentrations of administered drugs and a measure of potency of the combined drug effect termed the "'Noxious Stimulation Response Index' (NSRI). This dual-centre, prospective, observational study assesses whether the availability of SmartPilot® View alters the behaviour of anaesthetic drug titration of anaesthetists and improves the Anaesthesia Quality Score (AQS; percentage of time spent with MAP 60-80 mm Hg and Bispectral Index [BIS] 40-60 [blinded]).
METHODS
We recruited 493 patients scheduled for elective surgery in two university centres. A control group (CONTROL; n=170) was enrolled to observe drug titration in current practice. Thereafter, an intervention group was enrolled, for which SmartPilot® View was made available to optimise drug titration (SPV; n=188). The AQS, haemodynamic and hypnotic effects, recovery times, pain scores, and other parameters were compared between groups.
RESULTS
There were 358 patients eligible for analysis. Anaesthesia quality score was similar between CONTROL and SPV (median AQS [Q1-Q3]) 25.3% [7.4-41.5%] and 22.2% [8.0-44.4%], respectively; P=0.898). Compared with CONTROL, SPV patients had less severe hypotension and hypertension, less BIS <40, faster tracheal extubation, and lower early postoperative pain scores.
CONCLUSIONS
Adding SmartPilot® View information did not affect average drug titration behaviour. However, small improvements in control of MAP and BIS and early recovery suggest improved titration for some patients without increasing the risk of overdosing or underdosing.
CLINICAL TRIAL REGISTRATION
NCT01467167.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy |
UniBE Contributor: |
Bucher, Christian Hans, Schmalz, Livia, Luginbühl, Martin |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1471-6771 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
04 Apr 2022 10:58 |
Last Modified: |
05 Dec 2022 16:18 |
Publisher DOI: |
10.1016/j.bja.2022.02.033 |
PubMed ID: |
35361490 |
Uncontrolled Keywords: |
drug interaction drug titration general anaesthesia intraoperative monitoring pharmacodynamics |
BORIS DOI: |
10.48350/168943 |
URI: |
https://boris.unibe.ch/id/eprint/168943 |
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