Processed electroencephalography-guided general anesthesia and norepinephrine requirements: A randomized trial in patients having vascular surgery
Processed electroencephalography (pEEG) may help clinicians optimize depth of general anesthesia. Avoiding excessive depth of anesthesia may reduce intraoperative hypotension and the need for vasopressors. We tested the hypothesis that pEEG-guided – compared to non-pEEG-guided – general anesthesia r...
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| Veröffentlicht in: | Journal of clinical anesthesia 2024-08, Vol.95, p.111459, Article 111459 |
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| creator | Thomsen, Kristen K. Sessler, Daniel I. Krause, Linda Hoppe, Phillip Opitz, Benjamin Kessler, Till Chindris, Viorel Bergholz, Alina Flick, Moritz Kouz, Karim Zöllner, Christian Schulte-Uentrop, Leonie Saugel, Bernd |
| description | Processed electroencephalography (pEEG) may help clinicians optimize depth of general anesthesia. Avoiding excessive depth of anesthesia may reduce intraoperative hypotension and the need for vasopressors. We tested the hypothesis that pEEG-guided – compared to non-pEEG-guided – general anesthesia reduces the amount of norepinephrine needed to keep intraoperative mean arterial pressure above 65 mmHg in patients having vascular surgery.
Randomized controlled clinical trial.
University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
110 patients having vascular surgery.
pEEG-guided general anesthesia.
Our primary endpoint was the average norepinephrine infusion rate from the beginning of induction of anesthesia until the end of surgery.
96 patients were analyzed. The mean ± standard deviation average norepinephrine infusion rate was 0.08 ± 0.04 μg kg−1 min−1 in patients assigned to pEEG-guided and 0.12 ± 0.09 μg kg−1 min−1 in patients assigned to non-pEEG-guided general anesthesia (mean difference 0.04 μg kg−1 min−1, 95% confidence interval 0.01 to 0.07 μg kg−1 min−1, p = 0.004). Patients assigned to pEEG-guided versus non-pEEG-guided general anesthesia, had a median time-weighted minimum alveolar concentration of 0.7 (0.6, 0.8) versus 0.8 (0.7, 0.8) (p = 0.006) and a median percentage of time Patient State Index was |
| doi_str_mv | 10.1016/j.jclinane.2024.111459 |
| format | Article |
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Randomized controlled clinical trial.
University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
110 patients having vascular surgery.
pEEG-guided general anesthesia.
Our primary endpoint was the average norepinephrine infusion rate from the beginning of induction of anesthesia until the end of surgery.
96 patients were analyzed. The mean ± standard deviation average norepinephrine infusion rate was 0.08 ± 0.04 μg kg−1 min−1 in patients assigned to pEEG-guided and 0.12 ± 0.09 μg kg−1 min−1 in patients assigned to non-pEEG-guided general anesthesia (mean difference 0.04 μg kg−1 min−1, 95% confidence interval 0.01 to 0.07 μg kg−1 min−1, p = 0.004). Patients assigned to pEEG-guided versus non-pEEG-guided general anesthesia, had a median time-weighted minimum alveolar concentration of 0.7 (0.6, 0.8) versus 0.8 (0.7, 0.8) (p = 0.006) and a median percentage of time Patient State Index was <25 of 12 (1, 41) % versus 23 (3, 49) % (p = 0.279).
pEEG-guided – compared to non-pEEG-guided – general anesthesia reduced the amount of norepinephrine needed to keep mean arterial pressure above 65 mmHg by about a third in patients having vascular surgery. Whether reduced intraoperative norepinephrine requirements resulting from pEEG-guided general anesthesia translate into improved patient-centered outcomes remains to be determined in larger trials.
•To prevent and treat intraoperative hypotension, vasopressors are commonly used.•Avoiding excessive depth of anesthesia may reduce the need for vasopressors.•Processed electroencephalography helps avoid excessive anesthetic depth.•Processed electroencephalography reduces norepinephrine requirements</description><identifier>ISSN: 0952-8180</identifier><identifier>ISSN: 1873-4529</identifier><identifier>EISSN: 1873-4529</identifier><identifier>DOI: 10.1016/j.jclinane.2024.111459</identifier><identifier>PMID: 38599161</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute kidney injury ; Aged ; Anesthesia ; Anesthesia, General - methods ; Anesthesiology ; Arterial Pressure - drug effects ; Blood pressure ; Catheters ; Electroencephalography ; Electroencephalography - drug effects ; Female ; General anesthesia ; Hemodynamic monitoring ; Hemodynamics ; Humans ; Hypotension ; Hypotension - prevention & control ; Infusion pumps ; Male ; Medical personnel ; Middle Aged ; Monitoring, Intraoperative - methods ; Mortality ; Norepinephrine - administration & dosage ; Patient state index ; Patients ; Postoperative period ; Standard deviation ; Statistical analysis ; Surgical outcomes ; Vascular surgery ; Vascular Surgical Procedures - adverse effects ; Vasoconstrictor Agents - administration & dosage ; Vasopressor</subject><ispartof>Journal of clinical anesthesia, 2024-08, Vol.95, p.111459, Article 111459</ispartof><rights>2024 The Authors</rights><rights>Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.</rights><rights>2024. The Authors</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c391t-f13184895f6ef896557843510f95c64ca3593a0025a30c82d3b696d14c4ab8f63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0952818024000886$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38599161$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thomsen, Kristen K.</creatorcontrib><creatorcontrib>Sessler, Daniel I.</creatorcontrib><creatorcontrib>Krause, Linda</creatorcontrib><creatorcontrib>Hoppe, Phillip</creatorcontrib><creatorcontrib>Opitz, Benjamin</creatorcontrib><creatorcontrib>Kessler, Till</creatorcontrib><creatorcontrib>Chindris, Viorel</creatorcontrib><creatorcontrib>Bergholz, Alina</creatorcontrib><creatorcontrib>Flick, Moritz</creatorcontrib><creatorcontrib>Kouz, Karim</creatorcontrib><creatorcontrib>Zöllner, Christian</creatorcontrib><creatorcontrib>Schulte-Uentrop, Leonie</creatorcontrib><creatorcontrib>Saugel, Bernd</creatorcontrib><title>Processed electroencephalography-guided general anesthesia and norepinephrine requirements: A randomized trial in patients having vascular surgery</title><title>Journal of clinical anesthesia</title><addtitle>J Clin Anesth</addtitle><description>Processed electroencephalography (pEEG) may help clinicians optimize depth of general anesthesia. Avoiding excessive depth of anesthesia may reduce intraoperative hypotension and the need for vasopressors. We tested the hypothesis that pEEG-guided – compared to non-pEEG-guided – general anesthesia reduces the amount of norepinephrine needed to keep intraoperative mean arterial pressure above 65 mmHg in patients having vascular surgery.
Randomized controlled clinical trial.
University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
110 patients having vascular surgery.
pEEG-guided general anesthesia.
Our primary endpoint was the average norepinephrine infusion rate from the beginning of induction of anesthesia until the end of surgery.
96 patients were analyzed. The mean ± standard deviation average norepinephrine infusion rate was 0.08 ± 0.04 μg kg−1 min−1 in patients assigned to pEEG-guided and 0.12 ± 0.09 μg kg−1 min−1 in patients assigned to non-pEEG-guided general anesthesia (mean difference 0.04 μg kg−1 min−1, 95% confidence interval 0.01 to 0.07 μg kg−1 min−1, p = 0.004). Patients assigned to pEEG-guided versus non-pEEG-guided general anesthesia, had a median time-weighted minimum alveolar concentration of 0.7 (0.6, 0.8) versus 0.8 (0.7, 0.8) (p = 0.006) and a median percentage of time Patient State Index was <25 of 12 (1, 41) % versus 23 (3, 49) % (p = 0.279).
pEEG-guided – compared to non-pEEG-guided – general anesthesia reduced the amount of norepinephrine needed to keep mean arterial pressure above 65 mmHg by about a third in patients having vascular surgery. Whether reduced intraoperative norepinephrine requirements resulting from pEEG-guided general anesthesia translate into improved patient-centered outcomes remains to be determined in larger trials.
•To prevent and treat intraoperative hypotension, vasopressors are commonly used.•Avoiding excessive depth of anesthesia may reduce the need for vasopressors.•Processed electroencephalography helps avoid excessive anesthetic depth.•Processed electroencephalography reduces norepinephrine requirements</description><subject>Acute kidney injury</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesia, General - methods</subject><subject>Anesthesiology</subject><subject>Arterial Pressure - drug effects</subject><subject>Blood pressure</subject><subject>Catheters</subject><subject>Electroencephalography</subject><subject>Electroencephalography - drug effects</subject><subject>Female</subject><subject>General anesthesia</subject><subject>Hemodynamic monitoring</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Hypotension - prevention & control</subject><subject>Infusion pumps</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Middle Aged</subject><subject>Monitoring, Intraoperative - methods</subject><subject>Mortality</subject><subject>Norepinephrine - administration & dosage</subject><subject>Patient state index</subject><subject>Patients</subject><subject>Postoperative period</subject><subject>Standard deviation</subject><subject>Statistical analysis</subject><subject>Surgical outcomes</subject><subject>Vascular surgery</subject><subject>Vascular Surgical Procedures - adverse effects</subject><subject>Vasoconstrictor Agents - administration & dosage</subject><subject>Vasopressor</subject><issn>0952-8180</issn><issn>1873-4529</issn><issn>1873-4529</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkc1u1DAUhS0EokPhFSpLbNhksOOf2KyoKqBIlWABa8vj3GQcJXZqJyNNH6NPjEfTsmDDxrZ0vnOv7z0IXVGypYTKj8N2cKMPNsC2JjXfUkq50C_QhqqGVVzU-iXaEC3qSlFFLtCbnAdCSBHoa3TBlNCaSrpBjz9TdJAztBhGcEuKEBzMezvGPtl5f6z61bdF7SFAsiMuHfOyh-xtebY4xASzD8WRyokT3K8-wQRhyZ_wNU6FiZN_KAWW5IvdBzzbxZ90vLcHH3p8sNmto004r6mHdHyLXnV2zPDu6b5Ev79--XVzW939-Pb95vquckzTpeooo4orLToJndJSiEZxJijptHCSO8uEZpaQWlhGnKpbtpNatpQ7bneqk-wSfTjXnVO8X8tUZvLZwTiWEeOaDSOsYVoJyQv6_h90iGsK5XeF4lI0pGlIoeSZcinmnKAzc_KTTUdDiTmlZgbznJo5pWbOqRXj1VP5dTdB-9f2HFMBPp8BKPs4eEgmO38Kqi3Ldotpo_9fjz9k-K6r</recordid><startdate>202408</startdate><enddate>202408</enddate><creator>Thomsen, Kristen K.</creator><creator>Sessler, Daniel I.</creator><creator>Krause, Linda</creator><creator>Hoppe, Phillip</creator><creator>Opitz, Benjamin</creator><creator>Kessler, Till</creator><creator>Chindris, Viorel</creator><creator>Bergholz, Alina</creator><creator>Flick, Moritz</creator><creator>Kouz, Karim</creator><creator>Zöllner, Christian</creator><creator>Schulte-Uentrop, Leonie</creator><creator>Saugel, Bernd</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202408</creationdate><title>Processed electroencephalography-guided general anesthesia and norepinephrine requirements: A randomized trial in patients having vascular surgery</title><author>Thomsen, Kristen K. ; Sessler, Daniel I. ; Krause, Linda ; Hoppe, Phillip ; Opitz, Benjamin ; Kessler, Till ; Chindris, Viorel ; Bergholz, Alina ; Flick, Moritz ; Kouz, Karim ; Zöllner, Christian ; Schulte-Uentrop, Leonie ; Saugel, Bernd</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c391t-f13184895f6ef896557843510f95c64ca3593a0025a30c82d3b696d14c4ab8f63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Acute kidney injury</topic><topic>Aged</topic><topic>Anesthesia</topic><topic>Anesthesia, General - methods</topic><topic>Anesthesiology</topic><topic>Arterial Pressure - drug effects</topic><topic>Blood pressure</topic><topic>Catheters</topic><topic>Electroencephalography</topic><topic>Electroencephalography - drug effects</topic><topic>Female</topic><topic>General anesthesia</topic><topic>Hemodynamic monitoring</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Hypotension</topic><topic>Hypotension - prevention & control</topic><topic>Infusion pumps</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Middle Aged</topic><topic>Monitoring, Intraoperative - methods</topic><topic>Mortality</topic><topic>Norepinephrine - administration & dosage</topic><topic>Patient state index</topic><topic>Patients</topic><topic>Postoperative period</topic><topic>Standard deviation</topic><topic>Statistical analysis</topic><topic>Surgical outcomes</topic><topic>Vascular surgery</topic><topic>Vascular Surgical Procedures - adverse effects</topic><topic>Vasoconstrictor Agents - administration & dosage</topic><topic>Vasopressor</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thomsen, Kristen K.</creatorcontrib><creatorcontrib>Sessler, Daniel I.</creatorcontrib><creatorcontrib>Krause, Linda</creatorcontrib><creatorcontrib>Hoppe, Phillip</creatorcontrib><creatorcontrib>Opitz, Benjamin</creatorcontrib><creatorcontrib>Kessler, Till</creatorcontrib><creatorcontrib>Chindris, Viorel</creatorcontrib><creatorcontrib>Bergholz, Alina</creatorcontrib><creatorcontrib>Flick, Moritz</creatorcontrib><creatorcontrib>Kouz, Karim</creatorcontrib><creatorcontrib>Zöllner, Christian</creatorcontrib><creatorcontrib>Schulte-Uentrop, Leonie</creatorcontrib><creatorcontrib>Saugel, Bernd</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thomsen, Kristen K.</au><au>Sessler, Daniel I.</au><au>Krause, Linda</au><au>Hoppe, Phillip</au><au>Opitz, Benjamin</au><au>Kessler, Till</au><au>Chindris, Viorel</au><au>Bergholz, Alina</au><au>Flick, Moritz</au><au>Kouz, Karim</au><au>Zöllner, Christian</au><au>Schulte-Uentrop, Leonie</au><au>Saugel, Bernd</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Processed electroencephalography-guided general anesthesia and norepinephrine requirements: A randomized trial in patients having vascular surgery</atitle><jtitle>Journal of clinical anesthesia</jtitle><addtitle>J Clin Anesth</addtitle><date>2024-08</date><risdate>2024</risdate><volume>95</volume><spage>111459</spage><pages>111459-</pages><artnum>111459</artnum><issn>0952-8180</issn><issn>1873-4529</issn><eissn>1873-4529</eissn><abstract>Processed electroencephalography (pEEG) may help clinicians optimize depth of general anesthesia. Avoiding excessive depth of anesthesia may reduce intraoperative hypotension and the need for vasopressors. We tested the hypothesis that pEEG-guided – compared to non-pEEG-guided – general anesthesia reduces the amount of norepinephrine needed to keep intraoperative mean arterial pressure above 65 mmHg in patients having vascular surgery.
Randomized controlled clinical trial.
University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
110 patients having vascular surgery.
pEEG-guided general anesthesia.
Our primary endpoint was the average norepinephrine infusion rate from the beginning of induction of anesthesia until the end of surgery.
96 patients were analyzed. The mean ± standard deviation average norepinephrine infusion rate was 0.08 ± 0.04 μg kg−1 min−1 in patients assigned to pEEG-guided and 0.12 ± 0.09 μg kg−1 min−1 in patients assigned to non-pEEG-guided general anesthesia (mean difference 0.04 μg kg−1 min−1, 95% confidence interval 0.01 to 0.07 μg kg−1 min−1, p = 0.004). Patients assigned to pEEG-guided versus non-pEEG-guided general anesthesia, had a median time-weighted minimum alveolar concentration of 0.7 (0.6, 0.8) versus 0.8 (0.7, 0.8) (p = 0.006) and a median percentage of time Patient State Index was <25 of 12 (1, 41) % versus 23 (3, 49) % (p = 0.279).
pEEG-guided – compared to non-pEEG-guided – general anesthesia reduced the amount of norepinephrine needed to keep mean arterial pressure above 65 mmHg by about a third in patients having vascular surgery. Whether reduced intraoperative norepinephrine requirements resulting from pEEG-guided general anesthesia translate into improved patient-centered outcomes remains to be determined in larger trials.
•To prevent and treat intraoperative hypotension, vasopressors are commonly used.•Avoiding excessive depth of anesthesia may reduce the need for vasopressors.•Processed electroencephalography helps avoid excessive anesthetic depth.•Processed electroencephalography reduces norepinephrine requirements</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38599161</pmid><doi>10.1016/j.jclinane.2024.111459</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Acute kidney injury Aged Anesthesia Anesthesia, General - methods Anesthesiology Arterial Pressure - drug effects Blood pressure Catheters Electroencephalography Electroencephalography - drug effects Female General anesthesia Hemodynamic monitoring Hemodynamics Humans Hypotension Hypotension - prevention & control Infusion pumps Male Medical personnel Middle Aged Monitoring, Intraoperative - methods Mortality Norepinephrine - administration & dosage Patient state index Patients Postoperative period Standard deviation Statistical analysis Surgical outcomes Vascular surgery Vascular Surgical Procedures - adverse effects Vasoconstrictor Agents - administration & dosage Vasopressor |
| title | Processed electroencephalography-guided general anesthesia and norepinephrine requirements: A randomized trial in patients having vascular surgery |
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