Transcontinental anaesthesia: a pilot study.

BACKGROUND: Although telemedicine is one of the key initiatives of the World Health Organization, no study has explored the feasibility and efficacy of teleanaesthesia. This bi-centre pilot study investigates the feasibility of transcontinental anaesthesia. METHODS: Twenty patients aged ≥ 18 yr undergoing elective thyroid surgery for ≥ 30 min were enrolled in this study. The remote and local set-up was composed of a master-computer (Montreal) and a slave-computer (Pisa). Standard Internet connection, remote desktop control, and video conference software were used. All patients received total i.v. anaesthesia controlled remotely (Montreal). The main outcomes were feasibility, clinical performance, and controller performance of transcontinental anaesthesia. The clinical performance of hypnosis control was the efficacy to maintain bispectral index (BIS) at 45: 'excellent', 'good', 'poor', and 'inadequate' control represented BIS values within 10, from 11 to 20, from 21 to 30, or >30% from target. The clinical performance of analgesia was the efficacy to maintain Analgoscore values at 0 (-9 to 9); -3 to +3 representing 'excellent' pain control, -3 to -6 and +3 to +6 representing 'good' pain control, and -6 to -9 and +6 to +9 representing 'insufficient' pain control. The controller performance was evaluated using Varvel parameters. RESULTS: Transcontinental anaesthesia was successful in all 20 consecutive patients. The clinical performance of hypnosis showed an 'excellent and good' control for 69% of maintenance time, and the controller performance showed an average global performance index of 57. The clinical performance of analgesia was 'excellent and good' for 92% of maintenance time, and the controller performance showed a global performance index of 1118. CONCLUSIONS: Transcontinental anaesthesia is feasible; control of anaesthesia shows good performance indexes. Clinical registration number NCT01331096.

Evaluation of a novel closed-loop total intravenous anaesthesia drug delivery system: a randomized controlled trial.

BACKGROUND: We have developed an automatic anaesthesia system for closed-loop administration of anaesthesia drugs. The control variables used were bispectral index (BIS) and Analgoscore for hypnosis and antinociception, respectively. METHODS: One hundred and eighty-six patients were randomly enrolled in two groups. Propofol, remifentanil, and rocuronium were administered using closed-loop feedback control (closed-loop, n = 93) or manually (control group, n = 93). The clinical performance of hypnosis control was determined by calculating the offset from a BIS of 45: 'excellent', 'good', 'poor', and 'inadequate' control was defined as BIS values within 10%, from 11% to 20%, from 21% to 30%, or >30% offset from the target. The clinical performance of analgesia was defined as the offset from Analgoscore values. Data presented as mean (standard deviation) (95% confidence interval). RESULTS: Excellent or good control of hypnosis was achieved significantly longer in the closed-loop group [47.0 (9.8%) (45.0/49.0), 34.4 (4.7%) (33.5/35.4)] than in the control group [37.3 (14.3%) (34.4/40.2) and 32.3 (7.6%) (30.7/33.7)], respectively (P<0.0001 and 0.0085). Poor and inadequate control of hypnosis was significantly shorter in the closed-loop group [10.8 (5.0%) (9.8/11.8) and 7.7 (6.2%) (6.4/9.0)] than in the control group [14.7 (6.8%) (13.3/16.0) and 15.8 (14.7%) (12.8/18.8)], respectively (P<0.0001). Excellent control of analgesia was achieved significantly longer in the closed-loop group [78.7 (16.2%) (75.4/82.0)] than in the control group [73.7 (17.8%) (70.1/77.3)] (P=0.0456). CONCLUSIONS: The closed-loop system was better at maintaining BIS and Analgoscore than manual administration.