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BJA Advance Access originally published online on August 17, 2007
British Journal of Anaesthesia 2007 99(5):686-693; doi:10.1093/bja/aem231
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Narcotrend-assisted propofol/remifentanil anaesthesia vs clinical practice: does it make a difference?

I. Rundshagen1,*, T. Hardt1, K. Cortina3, F. Pragst2, T. Fritzsche1 and C. Spies1

1 Department of Anaesthesiology
2 Department of Legal Medicine, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Schumannstr., 20/21, D-10117 Berlin, Germany
3 Department of Psychology, University of Michigan, Ann Arbor, MI, USA

* Corresponding author. E-mail: ingrid.rundshagen{at}charite.de

Background: The Narcotrend is a computer-based EEG monitor designed to measure the depth of anaesthesia. The aim of the present study is to test the hypothesis that the intraoperative level of anaesthetic depth differs if decision-making is guided by Narcotrend monitoring or not.

Methods: Forty-eight patients undergoing elective surgery were randomized to receive a Narcotrend-controlled propofol/remifentanil anaesthetic regimen or standard clinical practice. In the EEG group, anaesthesia was adjusted to achieve a Narcotrend level of D2–E0, which is recommended for moderate to deep anaesthetic depth for surgery. EEG values were recorded continuously every 20 s in both groups. Depending on data distribution, group comparisons of the EEG parameters, propofol plasma concentration, and recovery characteristics were performed by analysis of variance for repeated measurements or non-parametric statistics.

Results: About 62 (SD 29)% of the Narcotrend values were within the target level in the EEG group during maintenance of anaesthesia; this was true for 64 (26)% of the data in the non-EEG group. The variance of the Narcotrend data was significantly lower in the EEG group compared with the non-EEG group [median: 0.4 (range: 3.5) vs 0.6 (2.5); P = 0.048]. There was no difference in propofol or remifentanil dosage, propofol plasma concentrations, and time for extubation. Ten minutes after extubation, visual analogue scores for nausea indicated a lower incidence in the Narcotrend group [7 (15) vs 24 (34); P = 0.005].

Conclusions: Guidance of anaesthesia with the Narcotrend-monitor leads to fewer deviations from a defined target than clinical assessment of anaesthetic depth only. This results in lower scores of nausea in the immediate period after anaesthesia.

Keywords: anaesthesia, depth; anaesthesia, general; anaesthetics i.v., propofol; analgesics opioids, remifentanil; equipment, monitors


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Home page
 Br J AnaesthHome page
O. D'Mello and I. Rundshagen
Narcotrend-assisted propofol/remifentanil anaesthesia for prevention of awareness
Br. J. Anaesth., March 1, 2008; 100(3): 421 - 421.
[Full Text] [PDF]

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Narcotrend-assisted propofol/remifentanil anaesthesia vs clinical practice: for prevention of awaren
Dr. Oswald D'Mello; FRCA, DA
British Journal of Anaesthesia, 6 Nov 2007 [Full text]
Response to the Letter of Dr. D'Mello
Ingrid Rundshagen
British Journal of Anaesthesia, 10 Jan 2008 [Full text]

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