In:
PLOS ONE, Public Library of Science (PLoS), Vol. 15, No. 12 ( 2020-12-22), p. e0244145-
Abstract:
Aging affects pharmacodynamics/pharmacokinetics of anesthetics, but age effects on Entropy-guided total intravenous anesthesia with target-controlled infusions (TIVA-TCI) are not fully characterized. We compared aging effects on effective estimated brain concentration of Propofol (CeP) during TIVA-TCI Entropy-guided anesthesia, without neuromuscular blockade (NMB). Methods We performed an observational, prospective, single-center study enrolling 75 adult women undergoing Entropy-guided Propofol-Remifentanil TIVA-TCI for breast surgery. Primary endpoint was the relationship between age and CeP at maintenance of anesthesia (MA) during Entropy-guided anesthesia. Secondary endpoints were relationships between age and CeP at arousal reaction (AR), return of consciousness (ROC) and explicit recall evenience. We calculated a linear model to evaluate the age’s impact on observational variable and performed pairwise tests to compare old (≥65 years, n = 50) and young ( 〈 65 years, n = 25) patients or patients with and without an AR. Results We did not observe age-related differences in CeP during MA, but CeP significantly (p = 0,01) decreased with age at ROC. Entropy values during MA increased with age and were significantly higher in the elderly (RE: median 56[IQR49.3–61] vs 47.5[42–52.5] ,p = 0.001; SE: 51.6[45–55.5] vs 44[IQR40-50] ,p = 0.005). 18 patients had an AR, having higher maximum RE (92.5[78–96.3] vs 65[56.5–80.5] ,p 〈 0.001), SE (79[64.8–84] vs 61[52.5–69] ,p = 0.03, RE-SE (12.5[9.5–16.5] vs 6 [3–9] ,p 〈 0.001. Conclusion Older age was associated with lower CeP at ROC, but not during MA in unparalysed patients undergoing breast surgery. Although RE and SE during MA, at comparable CeP, were higher in the elderly, Entropy, and in particular an increasing RE-SE, is a reliable index to detect an AR.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0244145
DOI:
10.1371/journal.pone.0244145.g001
DOI:
10.1371/journal.pone.0244145.g002
DOI:
10.1371/journal.pone.0244145.g003
DOI:
10.1371/journal.pone.0244145.t001
DOI:
10.1371/journal.pone.0244145.t002
DOI:
10.1371/journal.pone.0244145.t003
DOI:
10.1371/journal.pone.0244145.s001
DOI:
10.1371/journal.pone.0244145.s002
DOI:
10.1371/journal.pone.0244145.s003
DOI:
10.1371/journal.pone.0244145.s004
DOI:
10.1371/journal.pone.0244145.s005
DOI:
10.1371/journal.pone.0244145.r001
DOI:
10.1371/journal.pone.0244145.r002
DOI:
10.1371/journal.pone.0244145.r003
DOI:
10.1371/journal.pone.0244145.r004
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2020
detail.hit.zdb_id:
2267670-3
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