Utility of the SmartPilot (R) 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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)
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Abstract

Background: The advisory system SmartPilot (R) View (Dragerwerk AG, Lubeck, 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 (R) 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 (R) 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

Conclusions: Adding SmartPilot (R) 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.

Original languageEnglish
Pages (from-to)959-970
Number of pages12
JournalBritish Journal of Anaesthesia
Volume128
Issue number6
Early online date28-Mar-2022
DOIs
Publication statusPublished - Jun-2022

Keywords

  • drug interaction
  • drug titration
  • general anaesthesia
  • intraoperative monitoring
  • pharmacodynamics
  • BISPECTRAL INDEX
  • REMIFENTANIL
  • PROPOFOL
  • FENTANYL
  • MODEL
  • PHARMACODYNAMICS
  • EMERGENCE
  • EEG
  • AGE

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