Nitrous oxide does not produce a clinically important sparing effect during closed-loop delivered propofol–remifentanil anaesthesia guided by the bispectral.

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Presentation transcript:

Nitrous oxide does not produce a clinically important sparing effect during closed-loop delivered propofol–remifentanil anaesthesia guided by the bispectral index: a randomized multicentre study N. Liu, M. Le Guen, N. Boichut, A. Genty, T. Hérail, D. Schmartz, G. Khefif, A. Landais, J.J. Bussac, A. Charmeau, J. Baars, B. Rehberg, S. Tricoche, T. Chazot, D.I. Sessler, M. Fischler British Journal of Anaesthesia Volume 112, Issue 5, Pages 842-851 (May 2014) DOI: 10.1093/bja/aet479 Copyright © 2014 The Author(s) Terms and Conditions

Fig 1 Trial profile. M, male; F, female. N2O, patients were ventilated with 60% of nitrous oxide; AIR, patients were ventilated with 40% of oxygen. British Journal of Anaesthesia 2014 112, 842-851DOI: (10.1093/bja/aet479) Copyright © 2014 The Author(s) Terms and Conditions

Fig 2 Examples for the interpretation of automated control of propofol and remifentanil guided by the BIS. (a) Ninety-four per cent of anaesthesia maintenance the BIS was adequate or in the range 40 and 60 (BIS40–60) or pink area in the upper figure. The propofol and remifentanil lower limits were never reached. We can conclude that propofol and remifentanil titrations were performed correctly. (b) The BIS40–60 =26%, the pink area represents a period of too deep anaesthesia, the lower limits of propofol (1.3 µg ml−1) and remifentanil (3 ng ml−1) were reached and the controller could not decrease the concentrations. This case was excluded from the analysis. (c) The BIS40–60 =37%, the pink area represents a period of too deep anaesthesia, the lower propofol and remifentanil limits were increased (2 µg ml−1 and 4 ng ml−1, respectively) by the investigator and the controller could not decrease the concentrations. This case was excluded from the analysis. Upper figure: BIS value. Lower figure: effect-site concentration=calculated effect-site concentration of propofol (µg ml−1), or remifentanil (ng ml−1); green dashed line, propofol and blue thick line, remifentanil. British Journal of Anaesthesia 2014 112, 842-851DOI: (10.1093/bja/aet479) Copyright © 2014 The Author(s) Terms and Conditions

Fig 3 BIS values from induction to the discontinuation of propofol and remifentanil for all, male and female patients. Data are given as median values (blue thick line) with 10th and 90th percentiles (green fine line) with a moving average filter of 1 min duration for graphical representation. N2O, patients were ventilated with 60% of nitrous oxide; AIR, patients were ventilated with 40% of oxygen. British Journal of Anaesthesia 2014 112, 842-851DOI: (10.1093/bja/aet479) Copyright © 2014 The Author(s) Terms and Conditions

Fig 4 Histogram of propofol and remifentanil consumption. Distribution of propofol (left figures) and remifentanil (right figures) consumptions in all patients and by gender; P-values were reported for each figure. N2O, patients were ventilated with 60% of nitrous oxide; AIR, patients were ventilated with 40% of oxygen. Blue filled histograms represent the N2O group and green striped histograms represent the AIR group. Normal distribution curve for the N2O (pink dashed line) and AIR (orange solid line) groups. British Journal of Anaesthesia 2014 112, 842-851DOI: (10.1093/bja/aet479) Copyright © 2014 The Author(s) Terms and Conditions