BIS feedback closed-loop target-controlled infusion of propofol or etomidate in elderly patients with spinal surgery

Zhonglei Zheng; Yuqiang Su; Xiaoying Fan; Wanping Zhang; Jing Li; Sha Xue

BIS feedback closed-loop target-controlled infusion of propofol or etomidate in elderly patients with spinal surgery

Am J Transl Res. 2023 Feb 15;15(2):1231-1238. eCollection 2023.

Authors

Zhonglei Zheng¹, Yuqiang Su¹, Xiaoying Fan¹, Wanping Zhang¹, Jing Li¹, Sha Xue¹

Affiliation

¹ Department of Anesthesia, The Second Affiliated Hospital of Xi'an Medical University Xi'an 710038, Shaanxi, China.

PMID: 36915771
PMCID: PMC10006804

Abstract

Objective: To investigate the safety of etomidate anesthesia induction combined with Bispectral index (BIS) feedback closed-loop target-controlled infusion of propofol for spinal surgery in elderly patients.

Methods: Clinical data of 90 elderly patients who underwent elective spinal surgery were retrospectively analyzed. The patients were assigned to an etomidate group (n=48) and a propofol group (n=42) according to the different anesthesia methods. The etomidate group was anesthetized with etomidate combined with BIS feedback closed-loop target-controlled infusion, and the propofol group was anesthetized with closed-loop target-controlled infusion induced by propofol. The mean arterial pressure (MAP) and heart rate (HR) of the two groups were statistically analyzed 5 min after admission to the operating room (T0), the moment of the intubation (T1), 3 min after intubation (T2), 1 min before prone position (T3), 3 min after prone position (T4), the end of suture skin (T5) and 3 min after supine position (T6). In addition, the vasoactive drug application, awakening time, tracheal tube extraction time and incidence of postoperative complications were compared between the two groups.

Results: There were significant changes in MAP and HR from T0 to T1 in both groups (MAP: etomidate group t=5.677, P<0.001, propofol group t=8.093, P<0.001; HR: etomidate group t=2.731, P=0.008, propofol group t=3.967, P<0.001). MAP changes in etomidate group from T0 to T1 were less (MAP: t=4.236, P<0.001; t=2.082, P=0.040), and there was no significant difference in HR between the two groups (P>0.05). There were fewer patients receiving vasoactive drugs in the etomidate group (χ²=5.070, P=0.024), but no significant difference was found in the incidence of complications between the two groups, χ²=3.670, P=0.055.

Conclusion: Compared to propofol, the application of etomidate combined with BIS feedback closed-loop target-controlled infusion in spinal surgery anesthesia for elderly patients can keep hemodynamics in a stable state, without affecting postoperative resuscitation, showing high safety, so it is worthy of clinical application.

Keywords: BIS; Spinal surgery; anesthesia; elderly patients; etomidate; loop target controlled infusion; propofol.