Abstract
BackgroundThis study investigated the effects of indexes of consciousness (IoC1 and IoC2) monitoring on remifentanil dosage.MethodsIn 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.ResultsCompared 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).ConclusionsIoC1-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.Trial registrationTrial registration number: ChiCTR-TRC-13004101, registered on 27 November 2013.
Highlights
This study investigated the effects of indexes of consciousness (IoC1 and IoC2) monitoring on remifentanil dosage
Comparing the use of propofol and Discussion This study investigated the effects of IoC1 and IoC2 monitoring on remifentanil dosage
Results showed that compared with the C group, the mean remifentanil dose was significantly higher in the T group during the anesthetic period, as were the adjustment frequency of target-controlled infusion, but there was no difference in infusion duration
Summary
This study investigated the effects of indexes of consciousness (IoC1 and IoC2) monitoring on remifentanil dosage. Depth of anesthesia is commonly assessed in clinical practice by the patient’s clinical signs and symptoms such as blood pressure, heart rate variability, and body movement, but these measures are difficult to convert into a quantitative standard measure. Many studies have focused on IoC1 monitoring for sedative depth [4, 5], but only a few studies have focused on IoC2 monitoring for analgesic depth [6]. We applied IoC1 and IoC2 to the use of a sedative agent, propofol, and most importantly, an analgesic agent, remifentanil. We evaluated the effectiveness of IoC monitoring for anesthetic depth (IoC1 and IoC2) versus commonly used vital sign monitoring based on factors such as blood pressure and heart rate
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