Depth of anesthesia by Narcotrend® and postoperative characteristics in children undergoing cardiac surgery under extracorporeal circulation: a retrospective comparison of two anesthetic regimens

Anesthesia Medication's Impacts on Inflammatory and Neuroendocrine Immune Response in Patients Undergoing Digestive Endoscopy

The aim of this study was to explore the impact of anesthetic drugs currently used to perform lower digestive endoscopy on serum concentrations of inflammation markers and catecholamines. We selected 120 patients and divided them into three lots of 40 patients each: L1, in which no anesthetics were used; L2, in which propofol was used; and L3, in which propofol combined with fentanyl was used. All patients had serum concentrations of adrenaline/epinephrine (EPI), noradrenaline/norepinephrine (NE), tumor necrosis factor alpha (TNF-α), interleukin-4 (IL-4), IL-6, IL-8, and IL-10, taken at three time points: at the beginning of the endoscopic procedure (T0), 15 min after (T1), and 2 h after the end of the endoscopic procedure (T2). The results of the research showed changes in the levels of catecholamines and interleukins (ILs) at T0, with an increased response in L1 above the mean recorded in L2 and L3 (p < 0.001). At T1, increased values were recorded in all lots; values were significantly higher in L1. At T2, the values recorded in L3 were significantly lower than the values in L2 (student T, p < 0.001) and L1, in which the level of these markers continued to increase, reaching double values compared to T0 (student T, p < 0.001). In L2 at T1, the dose of propofol correlated much better with NE, EPI, and well-known cytokines. Our results show that propofol combined with fentanyl can significantly inhibit the activation of systemic immune and neuroendocrine response during painless lower digestive endoscopy.

A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children

The major therapeutic end points of general anesthesia include hypnosis, amnesia, and immobility. There is a complex relationship between general anesthesia, responsiveness, hemodynamic stability, and reaction to noxious stimuli. This complexity is compounded in pediatric anesthesia, where clinicians manage children from a wide range of ages, developmental stages, and body sizes, with their concomitant differences in physiology and pharmacology. This renders anesthetic requirements difficult to predict based solely on a child's age, body weight, and vital signs. Electroencephalogram (EEG) monitoring provides a window into children's brain states and may be useful in guiding clinical anesthesia management. However, many clinicians are unfamiliar with EEG monitoring in children. Young children's EEGs differ substantially from those of older children and adults, and there is a lack of evidence-based guidance on how and when to use the EEG for anesthesia care in children. This narrative review begins by summarizing what is known about EEG monitoring in pediatric anesthesia care. A key knowledge gap in the literature relates to a lack of practical information illustrating the utility of the EEG in clinical management. To address this gap, this narrative review illustrates how the EEG spectrogram can be used to visualize, in real time, brain responses to anesthetic drugs in relation to hemodynamic stability, surgical stimulation, and other interventions such as cardiopulmonary bypass. This review discusses anesthetic management principles in a variety of clinical scenarios, including infants, children with altered conscious levels, children with atypical neurodevelopment, children with hemodynamic instability, children undergoing total intravenous anesthesia, and those undergoing cardiopulmonary bypass. Each scenario is accompanied by practical illustrations of how the EEG can be visualized to help titrate anesthetic dosage to avoid undersedation or oversedation when patients experience hypotension or other physiological challenges, when surgical stimulation increases, and when a child's anesthetic requirements are otherwise less predictable. Overall, this review illustrates how well-established clinical management principles in children can be significantly complemented by the addition of EEG monitoring, thus enabling personalized anesthesia care to enhance patient safety and experience.

Meta-Analysis of the Prognostic Value of Narcotrend Monitoring of Different Depths of Anesthesia and Different Bispectral Index (BIS) Values for Cognitive Dysfunction after Tumor Surgery in Elderly Patients

Objective. To study the effect of Narcotrend monitoring on the incidence of early postoperative cognitive dysfunction (POCD) under different bispectral index (BIS) conditions and the effect of different depths of anesthesia on the incidence of POCD. Methods. We performed a literature search of PubMed, Embase, OVID (database system made by Ovid Technologies, USA), CBM (Chinese Biomedical Literature database), CNKI (China National Knowledge Infrastructure), Wanfang, and VIP databases (full-text database of Chinese sci-tech journals), etc., from the date of the establishment of the database until December 31, 2020. Our meta-analysis was focused on the collection and study of Narcotrend monitoring of different depths of anesthesia. We carefully read the abstracts and full texts of randomized controlled trials on the incidence of POCD in the early postoperative period, and their references were tracked. Data extraction and quality evaluation of the included literature were also performed, and RevMan 5.3 software was used for analysis. Results. In the end, eight articles were included, with a total of 714 patients. The meta-analysis results showed that four articles (255 patients) compared the state of deep anesthesia (BIS 30–40) with conventional anesthesia (BIS 40–60 earlier) after POCD. Also, the incidence of POCD on the first day after deep anesthesia (Narcotrend stage (NTS): negative correlation is currently the most appropriate EEG description; Nd can subdivide the original EEG into six stages and 15 levels (Nd Sg, NTS), namely, A (state of wakefulness) state, B0 B2 (sedated state), C0 C2 (light anesthetic state), D0 D2 (general anesthesia), and E0–E1) was significantly lower than that of conventional anesthesia (NTS DO–D1) (odds ratio (OR) = 0.21, 95% confidence interval (CI): 0.13–0.35, $P<0.00001$ ). Moreover, the incidence of POCD in deep anesthesia (NTS E1) at 7 days after surgery was significantly lower than that of conventional anesthesia (NTS D0) (OR (odds ratio) = 0.45, 95% CI: 0.23–0.91, $P=0.03$ ), while the incidence of POCD 7 days after NTS D2 in conventional anesthesia was significantly lower than that of NTS D0 (OR = 0.42, 95% CI: 0.24–0.71, $P=0.001$ ). Discussion. Deep anesthesia can reduce the incidence of POCD (OR = 0.40, 95% CI: 0.22–0.73, $P=0.002$ ). This meta-analysis included three studies (216 patients) that compared the early postoperative POCD incidence of BIS 40–50 under conventional anesthesia and BIS 50–60; the BIS 40–50 did not significantly reduce the incidence of POCD (OR = 1.11, 95% CI: 0.24–5.24, $P=0.9$ ). The incidence of POCD under deep anesthesia with Narcotrend monitoring was lower than that under conventional anesthesia.

Systematic review and meta-analysis of the prognostic value of Narcotrend monitoring of different depths of anesthesia and different Bispectral Index (BIS) values for cognitive dysfunction after tumor surgery in elderly patients

Background

To study the effect of Narcotrend monitoring on the incidence of early postoperative cognitive dysfunction (POCD) under different Bispectral Index (BIS) conditions and the effect of different depths of anesthesia on the incidence of POCD.

Methods

We performed a literature search of the PubMed, Embase, OVID (database system made by Ovid Technologies, USA), Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP Chinese Sci-tech Journals Database, Wanfang Data, etc. from the date of establishment of the database until December 31, 2020.

Results

In the end, eighty articles were included, with a total of 714 patients. The meta-analysis results showed that four articles (255 patients) compared the state of deep anesthesia (BIS 30–40) with conventional anesthesia (BIS 40–60 earlier) after POCD. Also, the incidence of POCD on the first day after deep anesthesia [Narcotrend stage (NTS): negative correlation is currently the most appropriate egg description; Nd can subdivide the original electroencephalogram (EEG) into six stages 15 levels (Nd Sg, NTS), or A (state of wakefulness), state B0–B2 (sedated state), state C0–C2 (light anesthetic state), state D0–D2 (general anesthesia), state E0–E2 (deep anesthesia state), and state F0–F2 (burst suppression state)] was significantly lower than that of conventional anesthesia (NTS D0–D1) [odds ratio (OR) =0.21, 95% confidence interval (CI): 0.13–0.35, P<0.00001]. Moreover, the incidence of POCD in deep anesthesia (NTS E1) at 7 days after surgery was significantly lower than that of conventional anesthesia (NTS D0) (OR =0.45, 95% CI: 0.23–0.91, P=0.03), while the incidence of POCD 7 days after NTS D2 in conventional anesthesia was significantly lower than that of NTS D0 (OR =0.42, 95% CI: 0.24–0.71, P=0.001).

Discussions

POCDs are thought to be the result of a combination of physical defects and precipitating factors in patients with their own physical impairments, and despite potential adverse effects, there is currently no consensus on the incidence of POCDs in patients with tumor, current risk factors, causes, and prevention strategies. Moreover, the level of evidence is low, and the deviation between different studies cannot be ruled out.