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Bi-spectral index guided closed-loop anaesthesia delivery system (CLADS™) in pheochromocytoma

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Abstract

Objectives. Anaesthetic management of pheochromocytoma is far from satisfactory even though various techniques are available. Feasibility as well as safety of Bi-spectral Index (BIS™)-guided closed-loop control of anaesthesia has been shown in various clinical settings. We evaluated the performance of BIS-guided closed-loop-anaesthesia-delivery system (CLADS) in patients undergoing resection of pheochromocytoma. Methods. Thirteen patients (7 males and 6 females, 15–65 years) who underwent adrenalectomy for pheochromocytoma in the past 4 years operated by a single surgeon were included in the study. Closed-loop-control of propofol-anaesthesia was induced and maintained with target BIS value =50. Results. Median performance error and median absolute performance error of target BIS control were 2 (2–7) [median (IQR)] and 10 (8–10), respectively. BIS was maintained within 50 ± 10 for 87 ± 8.6% (mean ± SD) of the valid CLAD time. Heart rate (HR) and mean arterial pressure (MAP) were maintained within ±25% of the baseline value for 90.3 ± 12.1% and 76.3 ± 13.2% of the time duration, respectively. BIS increased significantly following intubation, incision and tumor handling (P = 0.001, 0.001 and 0.03 respectively). There was a significant fall in both HR and MAP following induction of anaesthesia (P = 0.001), and MAP following tumor excision (P = 0.045) as compared to the baseline. Though maximum HR within 5 min post-intubation, post-incision and during tumor handling were significantly higher (P = 0.001, 0.014 and 0.037) compared to just before the respective event, they were not statistically different from the baseline. Though maximum MAP within 5 min post-intubation, post-incision and during tumor handling were significantly higher compared to MAP just before the respective event (P = 0.001, 0.021 and 0.001), they were not significantly different compared to the baseline value except maximum MAP during tumor handling (P = 0.001). Conclusion. CLADS performed well in patients undergoing pheochromocytoma surgeries which represent one of the few clinically extreme situations.

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Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India

    Harihar V. Hegde MD, G. D. Puri MD & Bhupesh Kumar MD, DM

  2. Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Arunanshu Behera MS

Authors
  1. Harihar V. Hegde MD
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  2. G. D. Puri MD
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  3. Bhupesh Kumar MD, DM
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  4. Arunanshu Behera MS
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Correspondence to G. D. Puri MD.

Additional information

Hegde HV, Puri GD, Kumar B, Behera A. Bi-spectral index guided closed-loop anaesthesia delivery system (CLADS™) in pheochromocytoma.

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Hegde, H.V., Puri, G.D., Kumar, B. et al. Bi-spectral index guided closed-loop anaesthesia delivery system (CLADS™) in pheochromocytoma. J Clin Monit Comput 23, 189–196 (2009). https://doi.org/10.1007/s10877-009-9181-0

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  • DOI: https://doi.org/10.1007/s10877-009-9181-0

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