Related Experiment Video
Updated: May 8, 2025
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Clinical evaluation of bispectral index-guided closed-loop infusion of propofol for preschool children: A
Lei Hua1, Bin Du2, Yunxia Zuo2
1Department of Anesthesiology Beijing Children's Hospital Capital Medical University, National Center for Children's Health Beijing China.
Insights
Closed-loop propofol infusion guided by bispectral index (BIS) offers safer and more accurate anesthesia in preschool children. This method provides better control over anesthesia depth compared to manual adjustments.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pharmacometrics
Background:
- Automated anesthesia delivery systems aim to improve patient safety and outcomes.
- Closed-loop propofol target-controlled infusion (TCI) models utilize feedback, such as the bispectral index (BIS), to regulate anesthetic depth.
- Preschool children present unique challenges in maintaining stable anesthesia due to physiological variations.
Purpose of the Study:
- To assess the safety and efficacy of BIS-guided closed-loop propofol TCI for maintaining general anesthesia in preschool children.
- To compare the accuracy and smoothness of anesthesia depth control between closed-loop and manual TCI methods.
Main Methods:
- A randomized controlled trial involving 119 preschool children (aged 1-6 years) undergoing anesthesia.
- Participants were divided into a closed-loop feedback group (Group C) and an open-loop manual control group (Group O).
- Anesthesia was maintained to target a BIS of 50, with infusion rates adjusted automatically (Group C) or manually (Group O) based on BIS and clinical parameters.
Main Results:
- The closed-loop group (Group C) achieved a significantly higher time ratio of adequate anesthesia (BIS 40-60) compared to the manual group (Group O).
- Group C exhibited lower time ratios of light anesthesia (BIS > 60) and improved global scores.
- Propofol infusion adjustments were more frequent in Group C, while remifentanil adjustments were less frequent.
Conclusions:
- BIS-guided closed-loop propofol infusion is a safe and effective strategy for anesthesia maintenance in preschool children.
- This automated approach provides more precise and stable control over anesthetic depth, enhancing patient safety.
Importance:
The closed-loop infusion system can automatically adjust and maintain the depth of anesthesia by using the propofol target-controlled infusion (TCI) model under the feedback guidance of the bispectral index (BIS).
Objective:
To evaluate the safety and superiority of closed-loop TCI of propofol guided by BIS during maintenance of generalized intravenous anesthesia for preschool children.
Methods:
A total of 120 children aged 1-6 years were enrolled and were divided into a closed-loop feedback group (Group C) and an open-loop manual control group (Group O), with 60 participants in each group. For anesthesia maintenance, the propofol infusion rate was adjusted by the injection system under the guidance of BIS in Group C and was manually adjusted by anesthesiologists according to the BIS and clinical experience in Group O, to maintain a BIS level of 50. The time ratio of adequate anesthesia (40 ≤ BIS ≤ 60), light anesthesia (BIS > 60), and deep anesthesia (BIS < 40) were recorded.
Results:
A total of 119 patients (59 in Group C and 60 in Group O) were enrolled in the study. Group C demonstrated a higher time ratio of adequate anesthesia (P = 0.014) compared to Group O. The time ratio of light anesthesia and the global score was lower in Group C than in Group O (P = 0.010, P = 0.015, respectively). The frequency of adjustment per unit of time was higher in Group C for propofol (P < 0.001), while it was lower for remifentanil (P = 0.010).
Interpretation:
BIS-guided closed-loop infusion of propofol is safe and effective for preschool children. The depth of anesthesia is controlled more accurately and smoothly.
