Alex Macario MD

Publication Details

  • TITRATION OF SEVOFLURANE IN ELDERLY PATIENTS: BLINDED, RANDOMIZED CLINICAL TRIAL, IN NON-CARDIAC SURGERY AFTER BETA-ADRENERGIC BLOCKADE JOURNAL OF CLINICAL MONITORING AND COMPUTING Drover, D. R., Schmiesing, C., Buchin, A. F., Ortega, H. R., Tanner, J. W., Atkins, J. H., Macario, A. 2011; 25 (3): 175-181

    Abstract:

    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.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.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.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).

    View details for DOI 10.1007/s10877-011-9293-1

    View details for Web of Science ID 000298814400004

    View details for PubMedID 21830049

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