The Influence of Electroencephalographic Density Spectral Array Guidance of Sevoflurane Administration on Recovery From General Anesthesia in Children. A Randomized Controlled Trial.

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Pediatric Anesthesia Pub Date : 2025-04-01 Epub Date: 2025-01-13 DOI:10.1111/pan.15065

Iris J de Heer, Hannah A C Raab, Joost de Vries, Gulhan Karaöz-Bulut, Frank Weber

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引用次数: 0

Abstract

Background: In children, monitoring depth of anesthesia is challenging because of the still developing brain. Electroencephalographic density spectral array monitoring provides age- and anesthetic drug-specific electroencephalographic patterns, making it suitable for use in children. Yet, not much is known about the benefits of using density spectral array on post-operative recovery in children.

Aim: In this randomized controlled trial, the primary aim was to investigate the influence of density spectral array monitoring during general anesthesia on the speed of recovery after surgery.

Methods: Children aged 6 months-12 years scheduled for elective surgery under general anesthesia supplemented with caudal analgesia had either sevoflurane anesthesia titrated to maintain a characteristic density spectral array pattern or based on a predefined end-tidal sevoflurane concentration of 2.3% (standard care group). The time interval between the discontinuation of sevoflurane and the moment when discharge criteria from the operating room were met (Steward score of 3 or more) was defined as the primary outcome parameter of this trial.

Results: Data from 96 children were analyzed. The time until discharge readiness from the operating room was shorter in group density spectral array (6 min. [13[4-16.8]]) than in group standard care (12 min. [18[6-24.3]]), with a difference between medians of 6 min (95% CI -7 to 0), p = 0.041. The mean end-tidal sevoflurane concentration during the surgical procedure was lower in group density spectral array, 1.8% (0.34) versus 2.3% (0.1) in group standard care (95% CI 0.4-0.7), p < 0.001.

Conclusion: This randomized controlled trial provides initial evidence of an added value of density spectral array monitoring in terms of the speed of recovery and allows sevoflurane to be dosed 22% lower during maintenance than with a more traditional approach using a minimal alveolar concentration of 0.9.

Trial registration: ClinicalTrials.gov identifier: NCT05525104.

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七氟醚给药脑电图密度谱阵列引导对儿童全麻恢复的影响。随机对照试验。

背景：在儿童中，由于大脑仍在发育，监测麻醉深度具有挑战性。脑电图密度谱阵列监测提供了年龄和麻醉药物特异性脑电图模式，使其适合用于儿童。然而，密度谱阵列对儿童术后恢复的益处尚不清楚。目的：在本随机对照试验中，主要目的是探讨全麻期间密度谱阵列监测对术后恢复速度的影响。方法：6个月至12岁的儿童计划在全身麻醉下进行择期手术，并辅以尾侧镇痛，他们要么滴定七氟醚麻醉以保持特征密度谱阵列模式，要么根据预先设定的潮汐末七氟醚浓度2.3%（标准护理组）。从停用七氟醚到达到手术室出院标准（Steward评分3分及以上）的时间间隔被定义为本试验的主要结局参数。结果：对96例患儿资料进行分析。组密度谱阵列显示，离手术室出院准备时间较短（6 min）。[13][4-16.8]])比对照组标准治疗（12分钟）短。[18][6-24.3]])，中位数差异为6分钟（95% CI -7 ~ 0）， p = 0.041。手术过程中，密度谱阵列组的平均七氟烷潮末浓度较低，为1.8%(0.34)，而标准护理组为2.3% (0.1)(95% CI 0.4-0.7)， p结论：该随机对照试验提供了密度谱阵列监测在恢复速度方面的附加价值的初步证据，并且在维持期间，七氟烷的剂量比使用最小肺泡浓度为0.9的更传统方法低22%。试验注册：ClinicalTrials.gov标识符：NCT05525104。

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来源期刊

Pediatric Anesthesia 医学-麻醉学

CiteScore

3.20

自引率

11.80%

发文量

222

审稿时长

3-8 weeks

期刊介绍： Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.