Dataset Information

Comparison of the target-controlled infusion and the manual infusion of propofol anesthesia during electroconvulsive therapy: an open-label randomized controlled trial.

ABSTRACT:

Background

Target-controlled infusion (TCI) of propofol is a well-established method of procedural sedation and has been used in Japan for anesthesia during electroconvulsive therapy (ECT). However, the usefulness of the TCI of propofol for ECT has yet to be determined. This study aimed to compare the TCI and manual infusion (MI) of propofol anesthesia during ECT.

Methods

A total of forty psychiatric inpatients receiving bitemporal ECT were enrolled in the present study and randomized into the TCI group (N?=?20) and the MI group (N?=?20). Clinical Global Impression (CGI) and Montreal Cognitive Assessment (MoCA) scores were measured before and after ECT. The clinical outcomes, anesthesia-related variables, and ECT-related variables were compared between the two groups. Generalized estimating equations (GEEs) were used to model the comparison throughout the course of ECT.

Results

A total of 36 subjects completed the present study, with 18 subjects in each group. Both the groups didn't significantly differ in the post-ECT changes in CGI and MoCA scores. However, concerning MoCA scores after 6 treatments of ECT, the MI group had improvement while the TCI group had deterioration. Compared with the MI group, the TCI group had higher doses of propofol, and longer procedural and recovery time. The TCI group seemed to have more robust seizures in the early course of ECT but less robust seizures in the later course of ECT compared with the MI group.

Conclusions

The present study does not support the use of TCI of propofol for anesthesia of ECT.

Trial registration

(ClinicalTrials.gov): NCT03863925 . Registered March 5, 2019 - Retrospectively registered.

SUBMITTER: Hsieh ML

PROVIDER: S-EPMC7863537 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Comparison of the target-controlled infusion and the manual infusion of propofol anesthesia during electroconvulsive therapy: an open-label randomized controlled trial.

Hsieh Meng-Ling ML Lu Yen-Ting YT Lin Chih-Chung CC Lee Chin-Pang CP

BMC psychiatry 20210204 1

<h4>Background</h4>Target-controlled infusion (TCI) of propofol is a well-established method of procedural sedation and has been used in Japan for anesthesia during electroconvulsive therapy (ECT). However, the usefulness of the TCI of propofol for ECT has yet to be determined. This study aimed to compare the TCI and manual infusion (MI) of propofol anesthesia during ECT.<h4>Methods</h4>A total of forty psychiatric inpatients receiving bitemporal ECT were enrolled in the present study and random ...[more]

PMID: 33541306

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Project description:BackgroundThe effects of circadian rhythms on drug metabolism and efficacy are being increasingly recognized. However, the extent to which they affect general anesthesia remains unclear. This study aims to investigate the effects of circadian rhythms on anesthetic depth and the concentrations of propofol target-controlled infusion (TCI).MethodsSixty patients undergoing laparoscopic surgeries were sequentially assigned to four groups. Group ND (n = 15): Propofol TCI with Narcotrend monitor during the day (8:00-18:00), Group NN (n = 15): Propofol TCI with Narcotrend monitor during the night (22:00-5:00), Group CLTD (n = 15): Propofol closed-loop TCI guided by bispectral index (BIS) during the day (8:00-18:00), Group CLTN (n = 15): Propofol closed-loop TCI guided by BIS during the night (22:00-5:00). The Narcotrend index, mean arterial pressure (MAP) and heart rate (HR) were compared between group ND and NN at 7 time points, from 5 min before induction to the end of operation. The propofol TCI concentrations, MAP and HR were compared between group CLTD and CLTN at 7 time points, from 5 min after induction to the end of operation.ResultsThe Narcotrend index, MAP, and HR in group NN were lower than those in group ND from the beginning of mechanical ventilation to the end of operation (p < 0.05). The propofol TCI concentrations in group CLTN were lower than those in group CLTD from the beginning of operation to the end of operation (p < 0.05).ConclusionCircadian rhythms have a significant effect on the depth of anesthesia and drug infusion concentrations during propofol TCI. When using general anesthesia during night surgery, the propofol infusion concentration should be appropriately reduced compared to surgery during the day.Trial registrationThe present study was registered on the ClinicalTrials.gov website ( NCT02440269 ) and approved by the Medical Ethics Committee of Southwest Hospital of Third Military Medical University (ethics lot number: 2016 Research No. 93). All patients provided informed written consent to participate in the study.

Project description:Background:Target-controlled infusion (TCI) propofol and sevoflurane are common agents for general anesthesia, including for kidney transplantation procedure. This study compared the effect of TCI propofol and sevoflurane on intraoperative hemodynamic profile in kidney transplant patients. Methods:A single-blinded prospective study was performed in 46 kidney transplant recipients who were randomized into receiving TCI propofol or sevoflurane as anesthetics maintenance. Hemodynamic parameters such as mean arterial pressure (MAP), cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI) were measured at baseline before induction, postintubation, first surgical incision, every 15 minutes after the first incision, reperfusion, and 15 minutes after reperfusion. Data were analyzed using unpaired t-test, paired t-test, and general linear model. Results:Intraoperative MAP, CI, SVI, and SVRI changes were similar in both groups (p?=?0.480, 0.216, 0.086, and 0.054). In comparison to the baseline value, TCI propofol and sevoflurane groups showed significant reductions of MAP at postintubation (p=0.010; p < 0.001) and during the first surgical incision (p=0.009; p < 0.001); significant reduction of CI at postintubation (p=0.003; p < 0.001) and during the first surgical incision (p < 0.001; p < 0.001); significant reduction of SVI at postintubation (p=0.013; p=0.008), during the first surgical incision (p=0.008; p=0.003), and 15 minutes after reperfusion (p=0.010; p=0.005); and significant increasing of SVRI during the first surgical incision (p=0.007; p=0.005). The TCI propofol group showed significantly lower SVRI compared to the sevoflurane group postintubation (p=0.029) and during the first surgical incision (p=0.026). Conclusion:Intraoperative hemodynamic profile was similar between the TCI propofol and sevoflurane group during kidney transplant surgery. The TCI propofol group had higher CI and SVI but showed significantly lower SVRI as compared to the sevoflurane group. The incidence of postanesthesia agitation, postoperative outcome, and complication were not significantly different between the two groups.

Project description:BACKGROUND:Intravertebral and general anesthesia (GA) are two main anesthesia approaches but both have defects. This study was aimed to evaluate the effect of subarachnoid anesthesia combined with propofol target-controlled infusion (TCI) on blood loss and transfusion for total hip arthroplasty (THA) in elderly patients in comparison with combined spinal-epidural anesthesia (CSEA) or GA. METHODS:Totally, 240 patients (aged ?65 years, American Society of Anesthesiologists [ASA] I-III) scheduled for posterior THA were enrolled from September 1st, 2017 to March 1st, 2018. All cases were randomly divided into three groups to receive CSEA (group C, n?=?80), GA (group G, n?=?80), or subarachnoid anesthesia and propofol TCI (group T, n?=?80), respectively. Primary outcomes measured were intra-operative blood loss, autologous and allogeneic blood transfusion, mean arterial pressure at different time points, length of stay in post-anesthesia care unit (PACU), length of hospital stay, and patient satisfaction degree. Furthermore, post-operative pain scores and complications were also observed. The difference of quantitative index between groups were analyzed by one-way analysis of variance, repeated measurement generalized linear model, Student-Newman-Keuls test or rank-sum test, while ratio index was analyzed by Chi-square test or Fisher exact test. RESULTS:Basic characteristics were comparable among the three groups. Intra-operative blood loss in group T (331.53?±?64.33?mL) and group G (308.03?±?64.90?mL) were significantly less than group C (455.40?±?120.48?mL, F?=?65.80, P?<?0.001). Similarly, the autologous transfusion of group T (130.99?±?30.36?mL) and group G (124.09?±?24.34?mL) were also markedly less than group C (178.31?±?48.68?mL, F?=?52.99, P?<?0.001). The allogenetic blood transfusion of group C (0 [0, 100.00]) was also significantly larger than group T (0) and group G (0) (Z?=?2.47, P?=?0.047). Except for the baseline, there were significant differences in mean arterial blood pressures before operation (F?=?496.84, P?<?0.001), 10-min after the beginning of operation (F?=?351.43, P?<?0.001), 30-min after the beginning of operation (F?=?559.89, P?<?0.001), 50-min after the beginning of operation (F?=?374.74, P?<?0.001), and at the end of operation (F?=?26.14, P?<?0.001) among the three groups. Length of stay in PACU of group T (9.41?±?1.19?min) was comparable with group C (8.83?±?1.26?min), and both were significantly shorter than group G (16.55?±?3.10?min, F?=?352.50, P?<?0.001). There were no significant differences among the three groups in terms of length of hospitalization and post-operative visual analog scale scores. Patient satisfaction degree of group T (77/80) was significantly higher than group C (66/80, ??=?7.96, P?=?0.004) and G (69/80, ??=?5.01, P?=?0.025). One patient complained of post-dural puncture headache and two complained of low back pain in group C, while none in group T. Incidence of post-operative nausea and vomiting in group G (10/80) was significantly higher than group T (3/80, ??=?4.10, P?=?0.043) and group C (2/80, ??=?5.76, P?=?0.016). No deep vein thrombosis or delayed post-operative functional exercise was detected. CONCLUSIONS:Single subarachnoid anesthesia combined with propofol TCI seems to perform better than CSEA and GA for posterior THA in elderly patients, with less blood loss and peri-operative transfusion, higher patient satisfaction degree and fewer complications. TRIAL REGISTRATION:chictr.org.cn: ChiCTR-IPR-17013461; http://www.chictr.org.cn/showproj.aspx?proj=23024.

Dataset Information

Comparison of the target-controlled infusion and the manual infusion of propofol anesthesia during electroconvulsive therapy: an open-label randomized controlled trial.

Background

Methods

Results

Conclusions

Trial registration

Publications

Comparison of the target-controlled infusion and the manual infusion of propofol anesthesia during electroconvulsive therapy: an open-label randomized controlled trial.

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