Anesthesia Depth During Opioid Free Anesthesia

Region Halland

Status: Completed

Conditions: Opioid-free Anesthesia; Anesthesia Depth Monitoring

Treatments: Procedure: Anesthesia depth monitoring

Study type: Observational

Funder types: Other

Identifiers

NCT06227143

2022-07156-02

Details and patient eligibility

About

Opioid-free anesthesia is feasible and effective but still not common practice. Anesthesia depth monitoring is not investigated for use in anesthesia combining low dose infusions of several drugs with different sedative patterns on EEG. This is an observational study comparing opioid-free anesthesia with regular anesthesia in regards to DSA, SEF and PSI from the Sedline monitor.

Full description

Patients who undergo general anaesthesia are more or less extensively monitored, with the sole purpose of surveilling depth of anesthesia and nociception. Parameters such as heart rate, blood pressure, pupillary size and sweating has historically been used as predictive markers for this surveillance. However, these clinical parameters have low predictive capacity and there is a tendency to overdue perioperative sedation and misinterpret sympathetically derived reactions as pain. This could lead to higher incidence of postoperative delirium and opioid induced hyperalgesia. On the contrary, an overestimated trust in the mentioned parameters might lead to increased risk of intra-operative awareness.

The usefulness of processed encephalography (pEEG) during anesthesia has since long been promoted for anesthesia providers. Since then, several commercial devices has been developed and deployed for clinical use. Although mixed results are presented in clinical studies there is now a significant empirical experience for its use in routine anesthesia with volatile anesthetics and propofol. Density spectral array (DSA) is the latest contribution in the field of encephalographic monitoring. It is a two-dimensional graph plotting the power of each frequency-interval on a time-scale.

More and more data on the effectiveness and safety of opioid free anaesthesia (OFA) have been released, especially as a direct result of the ongoing opioid-epidemic affecting a large number of people worldwide. The algorithms for the commercial devices, using DSA, has to this date not been validated for multimodal anesthetic regimens using ketamine and dexmedetomidine.

The purpose of this observational study is to compare DSA pattern and data for pEEG between OFA and total intravenous anaesthesia or general anaesthesia with volatile anesthetics for patients undergoing laparoscopic surgery.

Enrollment: 30 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Elective laparoscopic surgery
• Adult patients
• Ability to accomodate verbal and written information in swedish
• Voluntary

Exclusion criteria

• Pregnancy
• Intolerance to NSAID

Trial design

30 participants in 3 patient groups

Opioid-free anesthesia

Description:

Patients undergoing laparoscopic surgery under general anesthesia. Drugs used for the purpose of anesthesia: Ketamine Dexmedetomidine Propofol Sevoflurane Lidocaine Betamethasone Paracetamol NSAID

Treatment:

Procedure: Anesthesia depth monitoring

Target Controlled Infusion

Description:

Patients undergoing laparoscopic surgery under general anesthesia. Drugs used for the purpose of anesthesia: Propofol Remifentanil Oxycodone Paracetamol NSAID Bethametasone

Treatment:

Procedure: Anesthesia depth monitoring

Volatile anesthetics

Description:

Patients undergoing laparoscopic surgery under general anesthesia. Drugs used for the purpose of anesthesia: Sevoflurane Propofol Remifentanil Oxycodone Paracetmol NSAID Bethametasone

Treatment:

Procedure: Anesthesia depth monitoring