Utility of the SmartPilot® View advisory screen to improve anaesthetic drug titration and postoperative outcomes in clinical practice: a two-centre prospective observational trial
Merel H Kuizenga, Hugo E M Vereecke, Anthony R Absalom, Christian H Bucher, Laura N Hannivoort, Johannes P van den Berg, Livia Schmalz, Michel M R F Struys, Martin Luginbühl, Merel H Kuizenga, Hugo E M Vereecke, Anthony R Absalom, Christian H Bucher, Laura N Hannivoort, Johannes P van den Berg, Livia Schmalz, Michel M R F Struys, Martin Luginbühl
Abstract
Background: The advisory system SmartPilot® View (Drägerwerk AG, Lübeck, Germany) provides real-time, demographically adjusted pharmacodynamic information throughout anaesthesia, including time course of effect-site concentrations of administered drugs and a measure of potency of the combined drug effect termed the "'Noxious Stimulation Response Index' (NSRI). This dual-centre, prospective, observational study assesses whether the availability of SmartPilot® View alters the behaviour of anaesthetic drug titration of anaesthetists and improves the Anaesthesia Quality Score (AQS; percentage of time spent with MAP 60-80 mm Hg and Bispectral Index [BIS] 40-60 [blinded]).
Methods: We recruited 493 patients scheduled for elective surgery in two university centres. A control group (CONTROL; n=170) was enrolled to observe drug titration in current practice. Thereafter, an intervention group was enrolled, for which SmartPilot® View was made available to optimise drug titration (SPV; n=188). The AQS, haemodynamic and hypnotic effects, recovery times, pain scores, and other parameters were compared between groups.
Results: There were 358 patients eligible for analysis. Anaesthesia quality score was similar between CONTROL and SPV (median AQS [Q1-Q3]) 25.3% [7.4-41.5%] and 22.2% [8.0-44.4%], respectively; P=0.898). Compared with CONTROL, SPV patients had less severe hypotension and hypertension, less BIS <40, faster tracheal extubation, and lower early postoperative pain scores.
Conclusions: Adding SmartPilot® View information did not affect average drug titration behaviour. However, small improvements in control of MAP and BIS and early recovery suggest improved titration for some patients without increasing the risk of overdosing or underdosing.
Clinical trial registration: NCT01467167.
Keywords: drug interaction; drug titration; general anaesthesia; intraoperative monitoring; pharmacodynamics.
Conflict of interest statement
Declarations of interest ARA is an editor of the British Journal of Anaesthesia. The research group or department of MMRFS has received grants and funding from The Medicines Company (Parsippany, NJ, USA), Masimo (Irvine, CA, USA), Fresenius (Bad Homburg, Germany), Acacia Design (Maastricht, The Netherlands), and Medtronic (Dublin, Ireland), and honoraria from The Medicines Company, Masimo, Fresenius, Baxter (Deerfield, IL, USA), Medtronic, and Demed Medical (Temse, Belgium). MMRFS serves as a director and editorial board member of the British Journal of Anaesthesia, and associate editor for Anesthesiology. ML is supported by Drägerwerk AG through an unrestricted educational grant to the Department of Anaesthesia and Pain Medicine, University of Bern, Bern, Switzerland. ML also receives royalties from patents related to SmartPilot® View. The other authors have no conflicts to declare.
Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Source: PubMed