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Man vs Machine: Closed Loop or Manual Intravenous Anesthesia?

Man vs Machine: Closed Loop or Manual Intravenous Anesthesia? Cover Editor and Illustrator (Including Infographics) Infographics Postoperative cognitive dysfunction (POCD) is an unfortunate reality for many patients after surgery Abbreviation: BIS = bispectral index, POCD, postoperative cognitive dysfunction. and is multifactorial in etiology. The total anesthetic burden endured during the surgical procedure is clearly one variable that may impact the incidence and severity of POCD. Authors in this issue The Infographic is composed by Naveen Nathan, MD, Northwestern University Feinberg School of of Anesthesia & Analgesia asked whether the titration of intravenous anesthetics through closed- Medicine (n-nathan@northwestern.edu). Illustration by Naveen Nathan, MD. loop infusion might lower the total anesthetic delivered and offer the benefit of decreased POCD. Over 200 patients were randomized to either manual adjustment of propofol and remifentanil infu- The author declares no conflicts of interest. sions versus closed-loop titrations for noncardiac surgery. As this infographic shows, no difference in POCD was found between the 2 groups. This finding could be explained by multiple factors such as REFERENCE the power to detect POCD given the sample size, the tools used to define POCD, and the fact that remifentanil decreases the required amount of anesthetic in general. A multitude of other factors 1. Mahr N, Bouhake Y, Chopard G, et al. Postoperative neurocognitive disorders after closed-loop could also have influenced these results and are addressed in their discussion. Interestingly, the total versus manual target controlled-infusion of propofol and remifentanil in patients undergoing elec- amount of propofol used was lower for patients on closed-loop infusions versus manual administra- tive major noncardiac surgery: the randomized controlled Postoperative Cognitive Dysfunction- tion. Further studies are required to further explore the utility of closed-loop infusions and outcomes. Electroencephalographic-Guided Anesthetic Adminstration trial. Anesth Analg. 2021;133:837–847. Copyright © 2021 International Anesthesia Research Society 836 www.anesthesia-analgesia.org October 2021 Volume 133 Number 4 • • Copyright © 2021 International Anesthesia Research Society. Unauthorized reproduction of this article is prohibited. Reprints will not be available from the author. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Anesthesia & Analgesia Wolters Kluwer Health

Man vs Machine: Closed Loop or Manual Intravenous Anesthesia?

Anesthesia & Analgesia , Volume 133 (4) – Oct 14, 2021

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References (2)

Publisher
Wolters Kluwer Health
Copyright
Copyright © 2021 International Anesthesia Research Society
ISSN
0003-2999
eISSN
1526-7598
DOI
10.1213/ane.0000000000005731
Publisher site
See Article on Publisher Site

Abstract

Cover Editor and Illustrator (Including Infographics) Infographics Postoperative cognitive dysfunction (POCD) is an unfortunate reality for many patients after surgery Abbreviation: BIS = bispectral index, POCD, postoperative cognitive dysfunction. and is multifactorial in etiology. The total anesthetic burden endured during the surgical procedure is clearly one variable that may impact the incidence and severity of POCD. Authors in this issue The Infographic is composed by Naveen Nathan, MD, Northwestern University Feinberg School of of Anesthesia & Analgesia asked whether the titration of intravenous anesthetics through closed- Medicine (n-nathan@northwestern.edu). Illustration by Naveen Nathan, MD. loop infusion might lower the total anesthetic delivered and offer the benefit of decreased POCD. Over 200 patients were randomized to either manual adjustment of propofol and remifentanil infu- The author declares no conflicts of interest. sions versus closed-loop titrations for noncardiac surgery. As this infographic shows, no difference in POCD was found between the 2 groups. This finding could be explained by multiple factors such as REFERENCE the power to detect POCD given the sample size, the tools used to define POCD, and the fact that remifentanil decreases the required amount of anesthetic in general. A multitude of other factors 1. Mahr N, Bouhake Y, Chopard G, et al. Postoperative neurocognitive disorders after closed-loop could also have influenced these results and are addressed in their discussion. Interestingly, the total versus manual target controlled-infusion of propofol and remifentanil in patients undergoing elec- amount of propofol used was lower for patients on closed-loop infusions versus manual administra- tive major noncardiac surgery: the randomized controlled Postoperative Cognitive Dysfunction- tion. Further studies are required to further explore the utility of closed-loop infusions and outcomes. Electroencephalographic-Guided Anesthetic Adminstration trial. Anesth Analg. 2021;133:837–847. Copyright © 2021 International Anesthesia Research Society 836 www.anesthesia-analgesia.org October 2021 Volume 133 Number 4 • • Copyright © 2021 International Anesthesia Research Society. Unauthorized reproduction of this article is prohibited. Reprints will not be available from the author.

Journal

Anesthesia & AnalgesiaWolters Kluwer Health

Published: Oct 14, 2021

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