Evaluation of closed-loop anesthesia delivery for propofol anesthesia in pediatric cardiac surgery

Summary Objective The objective of this study was to compare the feasibility of closed‐loop anesthesia delivery with manual control of propofol in pediatric patients during cardiac surgery. Methods Forty ASA II‐III children, undergoing elective cardiac surgery under cardiopulmonary bypass (CPB) in a tertiary care hospital, were randomized to receive propofol either through a closed‐loop anesthesia delivery system (CL group) or through traditional manual control (manual group) to achieve a target BIS of 50. Patients were induced and subsequently maintained with a propofol infusion. The propofol usage and the efficacy of closed‐loop system in controlling BIS within ±10 of the target were compared with that of manual control. Results The maintenance of BIS within ±10 of target and intraoperative hemodynamic stability were similar between the two groups. However, induction dose of propofol was less in the CL group (2.06 ± 0.79 mg·kg−1) than the manual group (2.95 ± 1.03 mg·kg−1) (P = 0.006) with less overshoot of BIS during induction in the closed‐loop group (P = 0.007). Total propofol used in the off‐CPB period was less in the CL group (6.29 ± 2.48 mg·kg−1 h−1 vs 7.82 ± 2.1 mg·kg−1 h−1) (P = 0.037). Phenylephrine use in the pre‐CPB period was more in the manual group (16.92 ± 10.92 μg·kg−1 vs 5.79 ± 5.98 μg·kg−1) (P = 0.014). Manual group required a median of 18 (range 8–29) dose adjustments per hour, while the CL group required none. Conclusion This study demonstrated the feasibility of closed‐loop controlled propofol anesthesia in children, even in challenging procedures such as cardiac surgery. Closed‐loop system needs further and larger evaluation to establish its safety and efficacy.