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Importance The closed‐loop infusion system can automatically adjust and maintain the depth of anesthesia by using the propofol target‐controlled infusion (TCI) model under the feedback guidance of the bispectral index (BIS). Objective To evaluate the safety and superiority of closed‐loop TCI of propofol guided by BIS during maintenance of generalized intravenous anesthesia for preschool children. Methods A total of 120 children aged 1–6 years were enrolled and were divided into a closed‐loop feedback group (Group C) and an open‐loop manual control group (Group O), with 60 participants in each group. For anesthesia maintenance, the propofol infusion rate was adjusted by the injection system under the guidance of BIS in Group C and was manually adjusted by anesthesiologists according to the BIS and clinical experience in Group O, to maintain a BIS level of 50. The time ratio of adequate anesthesia (40 ≤ BIS ≤ 60), light anesthesia (BIS > 60), and deep anesthesia (BIS < 40) were recorded. Results A total of 119 patients (59 in Group C and 60 in Group O) were enrolled in the study. Group C demonstrated a higher time ratio of adequate anesthesia (P = 0.014) compared to Group O. The time ratio of light anesthesia and the global score was lower in Group C than in Group O (P = 0.010, P = 0.015, respectively). The frequency of adjustment per unit of time was higher in Group C for propofol (P < 0.001), while it was lower for remifentanil (P = 0.010). Interpretation BIS‐guided closed‐loop infusion of propofol is safe and effective for preschool children. The depth of anesthesia is controlled more accurately and smoothly. The closed‐loop infusion system feeds back the monitoring output signal to the control module to automatically achieve and maintain the target goal. Through a multi‐center study, we compared the closed‐loop feedback and open‐loop control of propofol under the guidance of bispectral index and verified that the closed‐loop propofol infusion system can be used safely and effectively for anesthesia in preschool children .

Gastrointestinal (GI) endoscopy is the major technique for diagnosis of GI disease and treatment. Various sedation and analgesia regimens such as midazolam, fentanyl, and propofol can be used during GI endoscopy. The purpose of the study was to compare propofol alone and propofol combination with midazolam and fentanyl in moderate sedation for GI endoscopy. One hundred patients undergoing GI endoscopy were enrolled in this study. All patients received a propofol target-controlled infusion (TCI) to maintain sedation during the procedure. Patients were randomly allocated into either Group P (propofol TCI alone) or Group C (combination of propofol TCI plus midazolam and fentanyl). Dermographic data, anesthetic parameters (sedation regimen, blood pressure, heart rate, and oxygen saturation), procedure parameters (procedure time, colonoscopy, or panendoscopy), propofol consumption, and adverse events (hypoxia, hypotension, and bradycardia) were all recorded. Postprocedural records included recovery time, postoperative adverse events (nausea, vomiting, dizziness, recall, and pain) and satisfaction. The average propofol consumption was 251 ± 83 mg in Group P and 159 ± 73 mg in Group C (p < 0.001). The incidence of transient hypotension was higher in Group P (p = 0.009). The recovery time and discharge time were both shorter in Group C (p < 0.001 and p = 0.006 respectively). Overall, postprocedural adverse events were similar in both groups. The postanesthetic satisfaction was comparable in both groups. TCI of propofol combined with midazolam and fentanyl achieved sedation with fewer hypotension episodes and shorter recovery and discharge time than propofol TCI alone in patients undergoing GI endoscopy.

Background：In this prospective randomized study,we compared the predicted blood and effect-site C50 for propofol and remifentanil target-controlled infusion （TCI） and the bispectral index （BIS） values at loss of consciousness （LOC） and response to a standard noxious painful stimulus （LOS） in elderly and young patients,respectively.We hypothesized that the elderly patients will require lower target concentration of both propofol and remifentanil at above two clinical end-points.Methods：There were 80 American Society of Anesthesiologists （ASA） physical status Ⅰ Ⅱ unpremedicated patients enrolled in this study,they were divided into elderly group （age ≥65 years,n =40） and young group （aged 18-54 years,n =40）.Propofol was initially given to a predicted blood concentration of 1.2 μg/ml and thereafter increased by 0.3 μg/ml every 30 s until Observer＇s Assessment of Alertness and Sedation score was 1.The propofol level was kept constant,and remifentanil was given to provide a predict blood concentration of 2.0 ng/ml,and then increased by 0.3 ng/ml every 30 s until loss of response to a tetanic stimulus.BIS （version 3.22,BIS Quattro sensor） was also recorded.Results：In elderly group,the propofol effect-site C50 at LOC of was 1.5 （1.4-1.6） μg/ml,was significantly lower than that of young group,which was 2.2 （2.1-2.3） μg/ml,the remifentanil effect-site C50 at LOS was 3.5 （3.3-3.7） ng/ml in elderly patients,was similar with 3.7 （3.6-3.8） ng/ml in young patients.Fifty percent of patients lost consciousness at a BIS value of 57.3 （56.4-58.1）,was similar with that of young group,which was 55.2 （54.0-56.3）.Conclusion：In elderly patients,the predicted blood and effect-site concentrations of propofol at LOC were lower than that of young patients.At same sedation status,predicted blood and effect-site concentrations of remifentanil required at LOS were similar in elderly and young patients.BIS were not affected by age.Low-propofol/high-opioid may be optional TCI strategy for elderly patients.

Whether low-concentration desflurane reinforces propofol-based intravenous anesthesia on maintenance of anesthesia for patients undergoing laparoscopic cholecystectomy is to be determined. The aim of this study was to investigate whether propofol-based anesthesia adding low-concentration desflurane is feasible for laparoscopic cholecystectomy. Fifty-two patients undergoing laparoscopic cholecystectomy were enrolled in the prospective, randomized, clinical trial. Induction of anesthesia was achieved in all patients with fentanyl 2 μg/kg, lidocaine 1 mg/kg, propofol 2 mg/kg, and rocuronium 0.8 mg/kg to facilitate tracheal intubation and to initiate propofol target-controlled infusion (TCI) to effect site concentration (Ce: 4 μg/mL with infusion rate 400 mL/h). The patients were then allocated into either propofol TCI based (group P) or propofol TCI adding low-concentration desflurane (group PD) for maintenance of anesthesia. The peri-anesthesia hemodynamic responses to stimuli were measured. The perioperative psychomotor test included p-deletion test, minus calculation, orientation, and alert/sedation scales. Group PD showed stable hemodynamic responses at CO2 inflation, initial 15 minutes of operation, and recovery from general anesthesia as compared with group P. There is no significant difference between the groups in operation time and anesthesia time, perioperative psychomotor functional tests, postoperative vomiting, and pain score. Based on our findings, the anesthetic technique combination propofol and desflurane for the maintenance of general anesthesia for laparoscopic cholecystectomy provided more stable hemodynamic responses than propofol alone. The combined regimen is recommended for patients undergoing laparoscopic cholecystectomy.

Background It is unclear if anaesthesia maintenance with propofol is advantageous or beneficial over inhalational agents. This study is intended to compare the effects of propofol vs. inhalational agents in maintaining general anaesthesia on patient-relevant outcomes and patient satisfaction. Methods Studies were identified by electronic database searches in PubMed™, EMBASE™ and the Cochrane™ library between 01/01/1985 and 01/08/2016. Randomized controlled trials (RCTs) of peer-reviewed journals were studied. Of 6688 studies identified, 229 RCTs were included with a total of 20,991 patients. Quality control, assessment of risk of bias, meta-bias, meta-regression and certainty in evidence were performed according to Cochrane. Common estimates were derived from fixed or random-effects models depending on the presence of heterogeneity. Post-operative nausea and vomiting (PONV) was the primary outcome. Post-operative pain, emergence agitation, time to recovery, hospital length of stay, post-anaesthetic shivering and haemodynamic instability were considered key secondary outcomes. Results The risk for PONV was lower with propofol than with inhalational agents (relative risk (RR) 0.61 [0.53, 0.69], p  < 0.00001). Additionally, pain score after extubation and time in the post-operative anaesthesia care unit (PACU) were reduced with propofol (mean difference (MD) − 0.51 [− 0.81, − 0.20], p  = 0.001; MD − 2.91 min [− 5.47, − 0.35], p  = 0.03). In turn, time to respiratory recovery and tracheal extubation were longer with propofol than with inhalational agents (MD 0.82 min [0.20, 1.45], p  = 0.01; MD 0.70 min [0.03, 1.38], p  = 0.04, respectively). Notably, patient satisfaction, as reported by the number of satisfied patients and scores, was higher with propofol (RR 1.06 [1.01, 1.10], p  = 0.02; MD 0.13 [0.00, 0.26], p  = 0.05). Secondary analyses supported the primary results. Conclusions Based on the present meta-analysis there are several advantages of anaesthesia maintenance with propofol over inhalational agents. While these benefits result in an increased patient satisfaction, the clinical and economic relevance of these findings still need to be addressed in adequately powered prospective clinical trials.

Objective: Procedural sedation management in geriatric patients undergoing cystoscopy requires careful monitoring due to age-related physiological changes and increased sensitivity to anaesthetic agents. Although both target-controlled infusion (TCI) and conventional total intravenous anaesthesia (TIVA) techniques with propofol are commonly used methods for sedation, their comparative effectiveness and safety in this population remain subjects of ongoing investigation. This study aims to compare the effectiveness of the two techniques in terms of time to induction, recovery time, hemodynamic stability, airway intervention requirements, and propofol consumption. Methods: This prospective, randomized study enrolled 60 male patients aged 65 years and older who were scheduled to undergo elective cystoscopy. Participants were randomly assigned to either the TCI group (n = 30) or the TIVA group (n = 30). The two groups were compared in terms of induction time, recovery time, hemodynamic parameters, airway interventions, and total propofol consumption. Results: Compared with the TCI group, the TIVA group presented significantly shorter induction-to-surgery initiation and recovery times (P=0.009 and P=0.016, respectively). However, systolic blood pressure was more stable in the TCI group compared to the TIVA group (P=0.014). Propofol consumption per unit time was greater in the TIVA group (P=0.048), although total propofol usage did not differ significantly. Airway intervention was more common in the TIVA group, particularly in the early phase; however, this difference was not significant. Conclusion: Both TCI and TIVA are effective sedation techniques for geriatric cystoscopy. While TIVA provides faster induction and recovery, TCI offers better hemodynamic stability and may reduce propofol requirements. Further studies are recommended to confirm these findings in broader patient populations.

This prospective, randomized controlled study aims to compare opioid doses in patients undergoing intracranial tumor surgery managed with Total Intravenous Anesthesia using Target Controlled Infusion (TIVA-TCI) combined with Nociception Level (NOL) monitoring. The NOL index, an artificial intelligence-driven multiparameter index, integrates physiological signals such as heart rate, skin conductance, and photoplethysmography to provide an objective measure of nociception and guide personalized opioid administration. Additionally, the study evaluates the consumption of hypnotic drugs, hemodynamic parameters, variability in the NOL index, and changes in Heart Rate (HR) in the study group patients who received NOL monitoring following severe noxious stimuli. The study involved 50 ASA II-III patients undergoing intracranial tumor surgery, with 25 in the standard care guided group and 25 in the NOL guided group. The control group received standard monitoring while NOL monitoring added in the study group. Propofol and remifentanil were titrated to maintain hemodynamic parameters or NOL values. Hemodynamic parameters, propofol and remifentanil doses were recorded and compared between groups. NOL index changes before and after noxious stimuli were compared with HR changes. No significant differences were found in demographic data between the two groups. The remifentanil dose administered was similar in both groups. The study group received a higher dose of propofol. However, the control group had a longer duration of operation. The NOL index showed a significantly higher change after severe noxious stimuli compared to Heart Rate, indicating greater sensitivity. This study compares NOL index monitoring to standard monitoring during intracranial tumor surgery. The results indicate that NOL monitoring is reliable in detecting and monitoring nociception events compared to heart rate changes. However, it does not lead to a significant reduction in opioid dose administration.

In the target-controlled infusion (TCI) of propofol and remifentanil intravenous anesthesia, accurate prediction of the depth of anesthesia (DOA) is very challenging. Patients with different physiological characteristics have inconsistent pharmacodynamic responses during different stages of anesthesia. For example, in TCI, older adults transition smoothly from the induction period to the maintenance period, while younger adults are more prone to anesthetic awareness, resulting in different DOA data distributions among patients. To address these problems, a deep learning framework that incorporates domain adaptation and knowledge distillation and uses propofol and remifentanil doses at historical moments to continuously predict the bispectral index (BIS) is proposed in this paper. Specifically, a modified adaptive recurrent neural network (AdaRNN) is adopted to address data distribution differences among patients. Moreover, a knowledge distillation pipeline is developed to train the prediction network by enabling it to learn intermediate feature representations of the teacher network. The experimental results show that our method exhibits better performance than existing approaches during all anesthetic phases in the TCI of propofol and remifentanil intravenous anesthesia. In particular, our method outperforms some state-of-the-art methods in terms of root mean square error and mean absolute error by 1 and 0.8, respectively, in the internal dataset as well as in the publicly available dataset.

We report a simple method for adjusting the weight input of the Marsh target-controlled infusion (TCI) model such that the resulting infusion regime closely mimics the behaviour of the Eleveld model, thereby making the Marsh model more precise for patients at the extremes of age and body mass index. To assess the performance of our method, we simulated 2768 subjects with diverse combinations of age, weight, height and sex undergoing a hypothetical four-hour propofol TCI using both the Marsh model with our weight adjustment and the Eleveld model. The weight adjusted Marsh model produced infusion regimes and corresponding effect site concentrations closely mimicking that of the Eleveld model at all time points, with median and maximum absolute performance errors less than 8.1% and 20.3%, respectively, across the entire cohort. Our weight adjustment method is a simple and robust way of improving the precision of the Marsh model in patients at extremes of age and body mass index, until general purpose TCI models for propofol, such as the Eleveld model, become more widely available in commercial infusion pumps.

This study aimed to compare the safety and efficacy of two target-controlled infusion (TCI) concentrations of propofol for sedation during cranial functional magnetic resonance imaging (fMRI) in children with autism spectrum disorder (ASD). A total of 120 preschool children with ASD scheduled for fMRI between January 2021 and July 2023 were enrolled and randomized into two groups: a low-concentration group (2.0 µg/mL, n  = 60) and a high-concentration group (2.5 µg/mL, n  = 60). Vital signs, sedation parameters, and adverse events were meticulously recorded to assess outcomes. The first-time sedation success rate was high and comparable between the 2.0 group and the 2.5 group (91.67% vs. 96.67%, p  = 0.439). However, the 2.5 group demonstrated a significant reduction in mean systolic blood pressure ( p  = 0.001). While the overall incidence of adverse events was not significantly different, respiratory and circulatory depression events were less frequent in the 2.0 group. Furthermore, the 2.0 group required a significantly lower maintenance dose of propofol ( p  < 0.001), experienced a shorter recovery time ( p  = 0.042), and had a smoother emergence profile. In conclusion, a propofol TCI concentration of 2.0 µg/mL is effective and safe for fMRI sedation in children with ASD and is clinically preferable to 2.5 µg/mL due to a more stable hemodynamic profile, reduced drug requirement, and faster, smoother recovery. Trial registration : ChiCTR2100050071.