Effects of circadian rhythm on Narcotrend index and target-controlled infusion concentration of propofol anesthesia

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.

Effects of different injection methods of propofol anesthesia on the behavior and electroencephalography recording in mice

Propofol is commonly used in mice studies on the mechanism of general anesthesia. The administration routes of propofol include intraperitoneal injection, single tail vein injection, and continuous tail vein pumping. The aim of this study is to compare the effects of the three injection methods on the behavior and electroencephalography (EEG) recording in mice. Mice were divided into an intraperitoneal injection group, a single tail vein injection group, and a continuous tail vein pumping group according to the propofol administration route. The indexes for observation were: time of loss of righting reflex (LORR), time of resumption of righting reflex (RORR), and change in the number of EEG spindle waves during anesthesia. The LORR and RORR were detected again after 1 week to determine the repeatability of the three administration routes. Death and behavioral change after anesthesia recovery in mice were recorded in the three groups. For propofol administration in mice, intraperitoneal injection induced long-duration anesthesia, but the depth of anesthesia was shallow and there was a risk of anesthesia accidents. A small dose of propofol administered through a single tail vein can induce loss of consciousness but the LORR time was not recorded, hence the metrics during induction of anesthesia were not investigated. Continuous tail vein pumping produced stable behavior and EEG recording during anesthesia induction and recovery in mice, and the individual difference was small. Continuous tail vein pumping is an ideal administration route for studying the mechanism of loss of consciousness of propofol anesthesia in mice, which could provide reference data for future mice experiments using propofol.

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.