Narcotrend Monitoring Allows Faster Emergence and a Reduction of Drug Consumption in Propofol–Remifentanil Anesthesia

Background The Narcotrend is a new electroencephalographic monitor designed to measure depth of anesthesia, based on a six-letter classification from A (awake) to F (increasing burst suppression) including 14 substages. This study was designed to investigate the impact of Narcotrend monitoring on recovery times and propofol consumption in comparison to Bispectral Index® (BIS®) monitoring or standard anesthetic practice. Methods With institutional review board approval and written informed consent, 120 adult patients scheduled to undergo minor orthopedic surgery were randomized to receive a propofol–remifentanil anesthetic controlled by Narcotrend, by BIS®, or solely by clinical parameters. Anesthesia was induced with 0.4 &mgr;g · kg−1 · min−1 remifentanil and a propofol target-controlled infusion at 3.5 &mgr;g/ml. After intubation, remifentanil was reduced to 0.2 &mgr;g · kg−1 · min−1, whereas the propofol infusion was adjusted according to clinical parameters or to the following target values: during maintenance to D0 (Narcotrend) or 50 (BIS®); 15 min before the end of surgery to C1 (Narcotrend) or 60 (BIS®). Recovery times were recorded by a blinded investigator, and average normalized propofol consumption was calculated from induction and maintenance doses. Results The groups were comparable for demographic data, duration of anesthesia, and mean remifentanil dosages. Compared with standard practice, patients with Narcotrend or BIS® monitoring needed significantly less propofol (standard practice, 6.8 ± 1.2 mg · kg−1 · h−1vs. Narcotrend, 4.5 ± 1.1 mg · kg−1 · h−1 or BIS®, 4.8 ± 1.0 mg · kg−1 · h−1;P < 0.001), opened their eyes earlier (9.3 ± 5.2 vs. 3.4 ± 2.2 or 3.5 ± 2.9 min), and were extubated sooner (9.7 ± 5.3 vs. 3.7 ± 2.2 or 4.1 ± 2.9 min). Conclusions The results indicate that Narcotrend and BIS® monitoring are equally effective to facilitate a significant reduction of recovery times and propofol consumption when used for guidance of propofol titration during a propofol–remifentanil anesthetic.

[1]  K. Ikeda,et al.  Electroencephalographic Derivatives as a Tool for Predicting the Depth of Sedation and Anesthesia Induced by Sevoflurane , 1998, Anesthesiology.

[2]  T. A. Bowdle,et al.  The Effect of Bispectral Index Monitoring on End-Tidal Gas Concentration and Recovery Duration After Outpatient Anesthesia , 2001, Anesthesia and analgesia.

[3]  T. Fuchs-Buder,et al.  [Time course of neuromuscular blockade after rocuronium. A comparison between women and men]. , 2000, Der Anaesthesist.

[4]  Peter S. Sebel,et al.  Development and Clinical Application of Electroencephalographic Bispectrum Monitoring , 2000, Anesthesiology.

[5]  P Manberg,et al.  Bispectral Analysis Measures Sedation and Memory Effects of Propofol, Midazolam, Isoflurane, and Alfentanil in Healthy Volunteers , 1997, Anesthesiology.

[6]  L. Kearse,et al.  Bispectral Analysis of the Electroencephalogram Predicts Conscious Processing of Information during Propofol Sedation and Hypnosis , 1998, Anesthesiology.

[7]  Jin Liu,et al.  Electroencephalographic Bispectral Index Correlates with Intraoperative Recall and Depth of Propofol-Induced Sedation , 1997, Anesthesia and analgesia.

[8]  Leslie S. Prichep,et al.  Patient State Index: Titration of Delivery and Recovery from Propofol, Alfentanil, and Nitrous Oxide Anesthesia , 2002, Anesthesiology.

[9]  C. Ménigaux,et al.  The Effect of Remifentanil on the Bispectral Index Change and Hemodynamic Responses After Orotracheal Intubation , 2000, Anesthesia and analgesia.

[10]  A. Yli-Hankala,et al.  EEG bispectral index monitoring in sevoflurane or propofol anaesthesia: analysis of direct costs and immediate recovery , 1999, Acta anaesthesiologica Scandinavica.

[11]  Paul F. White,et al.  Titration of Volatile Anesthetics Using Bispectral Index Facilitates Recovery after Ambulatory Anesthesia , 1997, Anesthesiology.

[12]  P. Sebel,et al.  Pediatric Anesthesia Society for Pediatric Anesthesia Section Editor the Effect of Bispectral Index Monitoring on Anesthetic Use and Recovery in Children Anesthetized with Sevoflurane in Nitrous Oxide , 2022 .

[13]  Paul F. White,et al.  Electroencephalogram Bispectral Analysis Predicts the Depth of Midazolam‐induced Sedation , 1996, Anesthesiology.

[14]  E Olofsen,et al.  The dynamic relationship between end-tidal sevoflurane and isoflurane concentrations and bispectral index and spectral edge frequency of the electroencephalogram. , 1999, Anesthesiology.

[15]  B Schultz,et al.  Automatic Classification Algorithms of the EEG Monitor Narcotrend for Routinely Recorded EEG Data from General Anaesthesia: a Validation Study , 2002, Biomedizinische Technik. Biomedical engineering.

[16]  S Howell,et al.  The Effect of the Interaction of Propofol and Alfentanil on Recall, Loss of Consciousness, and the Bispectral Index , 1998, Anesthesia and analgesia.

[17]  Peter S. Sebel,et al.  Bispectral Index Monitoring Allows Faster Emergence and Improved Recovery from Propofol, Alfentanil, and Nitrous Oxide Anesthesia , 1997 .

[18]  P. Sebel,et al.  Women emerge from general anesthesia with propofol/alfentanil/nitrous oxide faster than men. , 1999, Anesthesiology.

[19]  P. Sebel,et al.  Clinical impact of hypnotic-titration guidelines based on EEG bispectral index (BIS) monitoring during routine anesthetic care. , 2000, Journal of clinical anesthesia.

[20]  W. Fitch,et al.  Anaesthesia for carotid artery surgery. , 1976, British journal of anaesthesia.

[21]  A. Holdcroft,et al.  Drugs and sex differences: a review of drugs relating to anaesthesia. , 1999, British journal of anaesthesia.

[22]  Hilla Peretz,et al.  Ju n 20 03 Schrödinger ’ s Cat : The rules of engagement , 2003 .

[23]  M. Bauer,et al.  Einfluss des Geschlechts auf den Verlauf der neuromuskulären Blockade nach Rocuronium , 2000, Der Anaesthesist.

[24]  R. Thisted,et al.  BIS Monitoring to Prevent Awareness during General Anesthesia , 2001, Anesthesiology.

[25]  J. Bruhn,et al.  Shannon Entropy Applied to the Measurement of the Electroencephalographic Effects of Desflurane , 2001, Anesthesiology.

[26]  Technology assessment and the "learning contamination" bias. , 1994, Anesthesia and analgesia.

[27]  A. Loomis,et al.  Cerebral states during sleep, as studied by human brain potentials , 1937 .

[28]  S. Kreuer,et al.  The Narcotrend™– a new EEG monitor designed to measure the depth of anaesthesia A comparison with bispectral index monitoring during propofol-remifentanil-anaesthesia , 2001, Der Anaesthesist.

[29]  G Rolly,et al.  Clinical usefulness of the bispectral index for titrating propofol target effect‐site concentration , 1998, Anaesthesia.