BACKGROUND: Bispectral Index Scale (BIS)-guided closed-loop delivery of anesthetics has been extensively studied. We performed a meta-analysis of all the randomized clinical trials comparing efficacy and performance between BIS-guided closed-loop delivery and manually controlled administration of total IV anesthesia. METHODS: Scopus, PubMed, EMBASE, and the Cochrane Central Register of clinical trials were searched for pertinent studies. Inclusion criteria were random allocation to treatment and closed-loop delivery systems versus manually controlled administration of total IV anesthesia in any surgical setting. Exclusion criteria were duplicate publications and nonadult studies. RESULTS: Twelve studies were included, randomly allocating 1284 patients. Use of closed-loop anesthetic delivery systems was associated with a significant reduction in the dose of propofol administered for induction of anesthesia (mean difference [MD] = 0.37 [0.17–0.57], P for effect <0.00001, P for heterogeneity = 0.001, I 2 = 74%) and a significant reduction in recovery time (MD = 1.62 [0.60–2.64], P for effect <0.0001, P for heterogeneity = 0.06, I 2 = 47%). The target depth of anesthesia was preserved more frequently with closed-loop anesthetic delivery than with manual control (MD = −15.17 [−23.11 to −7.24], P for effect <0.00001, P for heterogeneity <0.00001, I 2 = 83%). There were no differences in the time required to induce anesthesia and the total propofol dose. Closed-loop anesthetic delivery performed better than manual-control delivery. Both median absolute performance error and wobble index were significantly lower in closed-loop anesthetic delivery systems group (MD = 5.82 [3.17–8.46], P for effect <0.00001, P for heterogeneity <0.00001, I 2 = 90% and MD = 0.92 [0.13–1.72], P for effect = 0.003, P for heterogeneity = 0.07, I 2 = 45%). CONCLUSIONS: When compared with manual control, BIS-guided anesthetic delivery of total IV anesthesia reduces propofol requirements during induction, better maintains a target depth of anesthesia, and reduces recovery time.
Closed-Loop Delivery Systems Versus Manually Controlled Administration of Total IV Anesthesia: A Meta-Analysis of Randomized Clinical Trials
Greco M;
2017-01-01
Abstract
BACKGROUND: Bispectral Index Scale (BIS)-guided closed-loop delivery of anesthetics has been extensively studied. We performed a meta-analysis of all the randomized clinical trials comparing efficacy and performance between BIS-guided closed-loop delivery and manually controlled administration of total IV anesthesia. METHODS: Scopus, PubMed, EMBASE, and the Cochrane Central Register of clinical trials were searched for pertinent studies. Inclusion criteria were random allocation to treatment and closed-loop delivery systems versus manually controlled administration of total IV anesthesia in any surgical setting. Exclusion criteria were duplicate publications and nonadult studies. RESULTS: Twelve studies were included, randomly allocating 1284 patients. Use of closed-loop anesthetic delivery systems was associated with a significant reduction in the dose of propofol administered for induction of anesthesia (mean difference [MD] = 0.37 [0.17–0.57], P for effect <0.00001, P for heterogeneity = 0.001, I 2 = 74%) and a significant reduction in recovery time (MD = 1.62 [0.60–2.64], P for effect <0.0001, P for heterogeneity = 0.06, I 2 = 47%). The target depth of anesthesia was preserved more frequently with closed-loop anesthetic delivery than with manual control (MD = −15.17 [−23.11 to −7.24], P for effect <0.00001, P for heterogeneity <0.00001, I 2 = 83%). There were no differences in the time required to induce anesthesia and the total propofol dose. Closed-loop anesthetic delivery performed better than manual-control delivery. Both median absolute performance error and wobble index were significantly lower in closed-loop anesthetic delivery systems group (MD = 5.82 [3.17–8.46], P for effect <0.00001, P for heterogeneity <0.00001, I 2 = 90% and MD = 0.92 [0.13–1.72], P for effect = 0.003, P for heterogeneity = 0.07, I 2 = 45%). CONCLUSIONS: When compared with manual control, BIS-guided anesthetic delivery of total IV anesthesia reduces propofol requirements during induction, better maintains a target depth of anesthesia, and reduces recovery time.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
