J Clin Monit Comput - Titration of sevoflurane in elderly patients: blinded, randomized clinical trial, in non-cardiac surgery after beta-adrenergic blockade.

Tópicos

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Resumo

CKGROUND: Monitoring depth of anesthesia via the processed electroencephalogram (EEG) has been found useful in reducing the amount of anesthetic drugs, optimizing wake-up times, and, in some studies, reducing awareness. Our goal was to determine if titrating sevoflurane as the maintenance anesthetic to a depth of anesthesia monitor (SEDLine?, Masimo, CA) would shorten time to extubation in elderly patients undergoing non-cardiac surgery while on beta-adrenergic blockade. This patient population was selected because the usual cardiovascular signs of inadequate general anesthesia may be masked by beta-blocker therapy.METHODS: Surgical patients older than 65?years of age receiving beta-adrenergic blockers for a minimum of 24?h preoperatively were randomized to two groups: a group whose titration of sevoflurane was based on SEDLine? data (SEDLine? group) and a group whose titration was based on usual clinical criteria (control group) where SEDLine? data were concealed. The primary endpoint was time from skin closure to time to extubation. Aldrete score, White Fast Track score and QoR-40 were also assessed.RESULTS: There was no significant difference in time to extubation [12.5 (SD 7.4)?min in the control group versus 13.0 (SD 5.9)?min for the treatment group]. The control group used more fentanyl [339 mcg (SD 205)] than did the treatment group [238 mcg (SD 123)] (P<0.02). There was no difference in sevoflurane utilization, Aldrete, White Fast Track scores, time to PACU discharge, or QoR-40 assessments between the groups.CONCLUSION: Use of the SEDLine? monitor's data to titrate sevoflurane did not improve the time to extubation or change short-term outcome of geriatric surgical patients receiving beta-adrenergic blockers. (ClinicalTrials.gov number, NCT00938782).

Resumo Limpo

ckground monitor depth anesthesia via process electroencephalogram eeg found use reduc amount anesthet drug optim wakeup time studi reduc awar goal determin titrat sevofluran mainten anesthet depth anesthesia monitor sedlin masimo ca shorten time extub elder patient undergo noncardiac surgeri betaadrenerg blockad patient popul select usual cardiovascular sign inadequ general anesthesia may mask betablock therapymethod surgic patient older year age receiv betaadrenerg blocker minimum h preoper random two group group whose titrat sevofluran base sedlin data sedlin group group whose titrat base usual clinic criteria control group sedlin data conceal primari endpoint time skin closur time extub aldret score white fast track score qor also assessedresult signific differ time extub sd min control group versus sd min treatment group control group use fentanyl mcg sd treatment group mcg sd p differ sevofluran util aldret white fast track score time pacu discharg qor assess groupsconclus use sedlin monitor data titrat sevofluran improv time extub chang shortterm outcom geriatr surgic patient receiv betaadrenerg blocker clinicaltrialsgov number nct

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