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Titration of sevoflurane in elderly patients: blinded, randomized clinical trial, in non-cardiac surgery after beta-adrenergic blockade

  • David R. Drover
  • Clifford Schmiesing
  • Anthea F. Buchin
  • H. Rick Ortega
  • Jonathan W. Tanner
  • Joshua H. Atkins
  • Alex Macario
Article

Abstract

Background

Monitoring depth of anesthesia via the processed electroencephalogram (EEG) has been found useful in reducing the amount of anesthetic drugs, optimizing wake-up times, and, in some studies, reducing awareness. Our goal was to determine if titrating sevoflurane as the maintenance anesthetic to a depth of anesthesia monitor (SEDLine™, Masimo, CA) would shorten time to extubation in elderly patients undergoing non-cardiac surgery while on beta-adrenergic blockade. This patient population was selected because the usual cardiovascular signs of inadequate general anesthesia may be masked by beta-blocker therapy.

Methods

Surgical patients older than 65 years of age receiving beta-adrenergic blockers for a minimum of 24 h preoperatively were randomized to two groups: a group whose titration of sevoflurane was based on SEDLine™ data (SEDLine™ group) and a group whose titration was based on usual clinical criteria (control group) where SEDLine™ data were concealed. The primary endpoint was time from skin closure to time to extubation. Aldrete score, White Fast Track score and QoR-40 were also assessed.

Results

There was no significant difference in time to extubation [12.5 (SD 7.4) min in the control group versus 13.0 (SD 5.9) min for the treatment group]. The control group used more fentanyl [339 mcg (SD 205)] than did the treatment group [238 mcg (SD 123)] (P<0.02). There was no difference in sevoflurane utilization, Aldrete, White Fast Track scores, time to PACU discharge, or QoR-40 assessments between the groups.

Conclusion

Use of the SEDLine™ monitor’s data to titrate sevoflurane did not improve the time to extubation or change short-term outcome of geriatric surgical patients receiving beta-adrenergic blockers. (ClinicalTrials.gov number, NCT00938782).

Keywords

geriatric sedline PSI EEG 

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • David R. Drover
    • 1
  • Clifford Schmiesing
    • 1
  • Anthea F. Buchin
    • 1
  • H. Rick Ortega
    • 2
  • Jonathan W. Tanner
    • 3
  • Joshua H. Atkins
    • 3
  • Alex Macario
    • 1
  1. 1.Department of AnesthesiaStanford UniversityStanfordUSA
  2. 2.iCAD Inc.NashuaUSA
  3. 3.University of Pennsylvania School of MedicinePhiladelphiaUSA

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