Isolated forearm technique: a meta-analysis of connected consciousness during different general anaesthesia regimens

全身麻醉 医学 术前用药 麻醉 前臂 金标准(测试) 外科 内科学
作者
Federico Linassi,Paolo Zanatta,Paola Tellaroli,Carlo Ori,Michele Carron
出处
期刊:BJA: British Journal of Anaesthesia [Elsevier]
卷期号:121 (1): 198-209 被引量:44
标识
DOI:10.1016/j.bja.2018.02.019
摘要

BackgroundGeneral anaesthesia should prevent patients from experiencing surgery, defined as connected consciousness. The isolated forearm technique (IFT) is the current gold standard for connected consciousness monitoring. We evaluated the efficacy of different anaesthesia regimens in preventing IFT responses.MethodsWe conducted a systematic review with meta-analysis of studies evaluating IFT in adults. Proportions of IFT-positive patients were compared for inhalational versus intravenous anaesthesia and anaesthesia brain monitor (ABM)-guided versus non-ABM-guided.ResultsOf 1131 patients in 22 studies, 393 (34.8%) had an IFT response during induction or maintenance. IFT-positive patients were less frequent during induction (19.7% [95% CI, 17.5–22.1]) than during maintenance (31.2% [95% CI, 27.8–34.8]). Proportions of IFT-positive patients during induction and maintenance were similar for inhalational (0.51 [95% CI, 0.38–0.65]) and intravenous (0.52 [95% CI, 0.26–0.77]) anaesthesia, but during maintenance were lower with inhalational (0.18 [95% CI, 0.08–0.38]) than with intravenous (0.48 [95% CI, 0.24–0.73]) anaesthesia. Proportions of IFT-positive patients during induction and maintenance were not significantly different for ABM-guided (0.64 [95% CI, 0.39–0.83]) and non-ABM-guided (0.48 [95% CI, 0.34–0.62]) anaesthesia but during maintenance were lower with non-ABM-guided (0.19 [95% CI, 0.09–0.37]) than with ABM-guided (0.57 [95% CI, 0.34–0.77]). Proportions of IFT-positive patients decreased significantly with increasing age and premedication use. Of the 34 anaesthesia regimens, 16 were inadequate. Studies had low methodological quality (only seven randomised controlled trials) and significant heterogeneity.ConclusionsStandard general anaesthesia regimens might not prevent connected consciousness. More accurate anaesthesia brain monitor methodology to reduce the likelihood of connected consciousness is desirable.
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