SmartPilot® view-guided anaesthesia improves postoperative outcomes in hip fracture surgery: a randomized blinded controlled study

TitreSmartPilot® view-guided anaesthesia improves postoperative outcomes in hip fracture surgery: a randomized blinded controlled study
Type de publicationArticle de revue
AuteurLeblanc, Damien, Conte, M., Masson, G., Richard, F., Jeanneteau, A., Bouhours, Guillaume, Chrétien, Jean Marie, Rony, Louis, Rineau, Emmanuel , Lasocki, Sigismond
EditeurElsevier
TypeArticle scientifique dans une revue à comité de lecture
Année2017
LangueAnglais
DateNovembre 2017
Numéro5
Pagination1022-1029
Volume119
Titre de la revueBritish Journal of Anaesthesia
ISSN00070912
Mots-clésanaesthesia, general, Hip Fractures, intraoperative, Length of Stay, Monitoring, Postoperative Complications
Résumé en anglais

Background

Both under-dosage and over-dosage of general anaesthetics can harm frail patients. We hypothesised that computer-assisted anaesthesia using pharmacokinetic/pharmacodynamic models guided by SmartPilot® View (SPV) software could optimise depth of anaesthesia and improve outcomes in patients undergoing hip fracture surgery.

Methods

This prospective, randomized, single-centre, blinded trial included patients undergoing hip fracture surgery under general anaesthesia. In the intervention group, anaesthesia was guided using SPV with predefined targets. In the control group, anaesthesia was delivered by usual practice using the same agents (propofol, sufentanil and desflurane). The primary endpoint was the time spent in the “appropriate anaesthesia zone” defined as bispectral index (BIS) (blinded to the anaesthetist during surgery) of 45–60 and systolic arterial pressure of 80–140 mm Hg. Postoperative complications were recorded for one month in a blinded manner.

Results

Of 100 subjects randomised, 97 were analysed (n=47 in SPV and 50 in control group). Anaesthetic drug consumption was reduced in the SPV group (for propofol and desflurane). Intraoperative duration of low BIS (<45) was similar, but cumulative time of low systolic arterial pressure (<80 mm Hg) was significantly shorter in the SPV group (median (Q1-Q3); 3 (0–40) vs 5 (0–116) min, P=0.013). SPV subjects experienced fewer moderate or major postoperative complications at 30-days (8 (17)% vs 18 (36)%, P=0.035) and shorter length of hospitalisation (8 (2–20) vs 8 (2–60) days, P=0.017).

Conclusions

SmartPilot® View-guided anaesthesia reduces intraoperative hypotension duration, occurrence of postoperative complications and length of stay in hip fracture surgery patients.

URL de la noticehttp://okina.univ-angers.fr/publications/ua18449
DOI10.1093/bja/aex317
Lien vers le document

https://bjanaesthesia.org/article/S0007-0912(17)53918-5/fulltext

Titre abrégéBritish Journal of Anaesthesia