Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942013000300008
Brazilian Journal of Anesthesiology
Scientific Article

Aplicação do monitor Narcotrend® para avaliar a profundidade da anestesia em crianças submetidas à cirurgia cardíaca: estudo prospectivo e controlado

Application of Narcotrend® monitor for evaluation of depth of anesthesia in infants undergoing cardiac surgery: a prospective control study

Yiyan Jiang; Bin Qiao; Lili Wu; Xiaona Lin

http://dx.doi.org/10.1590/S0034-70942013000300008 Braz J Anesthesiol, vol.63, n3, p.273-278, 2013
PDF Português
PDF English
Downloads: 0
Views: 1047

Resumo

JUSTIFICATIVA E OBJETIVOS: Investigar a eficácia clínica, segurança e viabilidade do monitor Narcotrend® para avaliar a profundidade da anestesia em crianças com doença cardíaca congênita (DCC) submetidas à cirurgia cardíaca. MÉTODOS: Foram randomicamente selecionadas 80 crianças submetidas à anestesia geral em cirurgia seletiva. As crianças foram divididas em dois grupos de forma aleatória (n = 40 por grupo). No grupo Narcotrend, a profundidade da anestesia foi monitorada com o Narcotrend. No grupo padrão, a profundidade da anestesia foi controlada de acordo com a experiência clínica. A pressão arterial média (PAM) e a frequência cardíaca (FC) foram determinadas e a dose de fentanil e relaxante muscular e os tempos de recuperação e de extubação foram registrados. RESULTADOS: Em ambos os grupos, os sinais vitais apresentaram-se estáveis durante a cirurgia. No grupo Narcotrend, a PAM e a FC foram mais estáveis, a dose total de fentanil e relaxante muscular significativamente menor e os tempos de recuperação e extubação acentuadamente mais reduzidos em comparação com o grupo padrão. CONCLUSÃO: A aplicação do monitor Narcotrend para medir a profundidade da anestesia foi útil para controlar a profundidade da anestesia em crianças com DCC que receberam anestesia intravenosa total, na qual uma pequena quantidade de narcóticos pode obter a anestesia ideal. Além disso, os tempos de recuperação e extubação foram menores e os efeitos secundários, como sensibilização intraoperatória, puderam ser evitados.

Palavras-chave

DOENÇAS, Congênita, Lactente, MONITORAÇÃO, TÉCNICAS ANESTÉSICAS, Geral, venosa, TÉCNICAS DE MEDIÇÃO, Eletroencefalografia

Abstract

BACKGROUND AND OBJECTIVES: To investigate the clinic effectiveness, safety and feasibility of Narcotrend® monitor for evaluation of depth of anesthesia in congenital heart disease (CHD) infants undergoing cardiac surgery. METHODS: A total of 80 infants receiving general anesthesia in selective surgery were randomly selected. Infants were assigned into two groups (n = 40 per group). In the Narcotrend group, the depth of anesthesia was monitored with the Narcotrend monitor. In the standard group, the depth of anesthesia was controlled according to the experience. The mean arterial pressure (MAP) and heart rate (HR) were determined, as well as the dose of fentanyl, muscle relaxant, recovery time and extubation time were recorded. RESULTS: In both groups, vital signs were stable during the surgery. When compared with the standard group, the MAP and HR were more stable, the total dose of fentanyl and muscle relaxant were significantly reduced and the recovery time and extubation time were markedly shortened in the Narcotrend group. CONCLUSION: The application of Narcotrend monitor was beneficial to the control of the depth of anesthesia in CHD infants receiving total intravenous anesthesia, in which small amount of narcotics can achieve optimal anesthesia. Moreover, the recovery time and extubation time are reduced and the harmful consequence such as intraoperative awareness can be avoided.

Keywords

Electroencephalography, Infant, Heart Diseases, Anesthesia, Intravenous, Monitoring

References

Tang ZH, Liu SH, Cheng ZG, Li QC, Wang YJ, Guo QL. Narcotrend for monitoring the anesthetic depth during endotracheal intubation in sevoflurane anaesthesia. Nan Fang Yi Ke Da Xue Xue Bao. 2010;30(7):1654-1657.

Gan TJ, Glass PS, Windsor A, Payne F, Rosow C, Sebel P, Manberg P. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anaesthesia. Anesthesiology. 1997;87:808-815.

Schultz B, Grouven U, Schultz A. Automatic classification algorithms of the EEG monitor Narcotrend for routinely recorded EEG data from general anaesthesia: a validation study. Biomed Technik. 2002;47:9-13.

Lai RC, Lu YL, Huang W. Application of a narcotrend-assisted anaesthesia in-depth monitor in the microwave coagulation for liver cancer during total intravenous anaesthesia with propofol and fentanyl. Chin J Cancer. 2010;29(1):117-120.

Davidson AJ, Huang GH, Czarnecki C. Awareness during anaesthesia in children: a prospective cohort study. Anesth Analg. 2005;100:653-661.

Mazoit JX. Pharmacokinetic/pharmacodynamic modeling of anesthetics in children: therapeutic implications. Paediatr Drugs. 2006;8:139-150.

Powers KS, Nazarian EB, Tapyrik SA. Bispectral index as a guide for titration of propofol during procedural sedation among children. Pediatrics. 2005;115:1666-1674.

Schneider G, Kochs EF, Horn B, Kreuzer M, Ningler M. Narcotrend® does not adequately detect the transition between awareness and unconsciousness in surgical patients. Anesthesiology. 2004;101:1105-1111.

Kreuer S, Bruhn J, Larsen R, Bialas P, Wilhelm W. Comparability of NarcotrendTM index and bispectral index during propofol anaesthesia. Br J Anaesth. 2004;93:235-240.

Weber F, Gruber M, Taeger K. The correlation of the Narcotrend® Index and classical electroencephalographic parameters with endtidal desflurane concentrations and hemodynamic parameters in different age groups. Paediatr Anaesth. 2005;15:378-384.

Weber F, Hollnberger H, Gruber M, Frank B, Taeger K. The correlation of the Narcotrend Index with endtidal sevoflurane concentrations and hemodynamic parameters in children. Pediatr Anesth. 2005;15:727-732.

Kent CD, Domino KB. Depth of anaesthesia. Curr Opin Anaesthesiol. 2009;22(6):782-787.

Kreuer S, Biedler A, Larsen R, Altmann S, Wilhelm W. Narcotrend monitoring allows faster emergence and a reduction of drug consumption in propofol-remifentanil anaesthesia. Anesthesiology. 2003;99:34-41.

Kreuer S, Wilhelm W. The Narcotrend monitor. Best Pract Res Clin Anaesthesiol. 2006;20(1):11111-9.

Panousis P, Heller AR, Burghardt M, Bleyl JU, Koch T. The effects of electromyographic activity on the accuracy of the Narcotrend monitor compared with the Bispectral Index during combined anaesthesia. Anaesthesia. 2007;62(9):868-874.

Sinha PK, Koshy T. Monitoring devices for measuring the depth of anaesthesia: An overview. Indian Journal of Anaesthesia. 2007;51(5):365-381.

Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. Lancet. 2000;355(9205):707-711.

Palanca BJ, Mashour GA, Avidan MS. Processed electroencephalogram in depth of anaesthesia monitoring. Curr Opin Anaesthesiol. 2009;22(5):553-559.

Kreuer S, Wilhelm W. The Narcotrend monitor. Best Pract Res Clin Anaestheisol. 2006;20:111-119.

Honan D, Doherty D, Feizelle H. A comparison of the effects on bispectral index of mild vs. moderate hypothermia during cardiopulmonary bypass. Eur J Anaesthesiol. 2006;23(5):385-390.

5dd423590e8825350dc63495 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections