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Tesi etd-02202017-230218


Thesis type
Tesi di laurea specialistica LC6
Author
FILIPPO, ROSALINDA
URN
etd-02202017-230218
Title
Closed-loop or Automated titration of Intravenous Anesthesia: Background, Science and Clinical Impact
Struttura
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
MEDICINA E CHIRURGIA
Commissione
relatore Prof. Forfori, Francesco
correlatore Dott.ssa Assenzo, Valentina
Parole chiave
  • automated titration
  • closed-loop
  • intravenous anesthesia
Data inizio appello
14/03/2017;
Consultabilità
parziale
Data di rilascio
14/03/2020
Riassunto analitico
Automated controllers have been used for a range of different circumstances and patient population from pediatric patients[82, 78, 55, 79], to an adult suffering from gigantism,[93] to pheochromocytoma surgery[28], application at high altitude[29, 6], use during lung [89] or liver transplantation,[90] for the morbidly obese patients[5, 87] and for cardiac surgery with cardiopulmonary bypass in adult[27, 83] and pediatric patients.[30] In adult patients automated titration results decreased in propofol doses during induction [25, 26, 23] and maintenance of general anesthesia.[26]. Automated induction can also be faster than manual induction[23] and automated control of depth of anesthesia is associated with shorter time to tracheal extubation.[25, 26, 32] In adult patients scheduled for elective cardiac surgery the automated titration of propofol improves hemodynamic stability and reduces propofol and vasopressor consumption.[27]. In pediatric patients scheduled for cardiac surgery, the automated titration of propofol decreases the use of phenylephrine and the amount of propofol for induction and during the off-cardiopulmonary bypass period.[30] Moreover, during major vascular or thoracic surgeries the use of an automated controller decreases the workload in particular during the induction period and improves hemodynamic stability during maintenance.[99]. The use of automated intravenous sedation in ICU for severely ill patients improves the quality of sedation, reduced propofol consumption by two-fold and improved hemodynamic stability.[75]<br>These studies highlight the clinical interest of automated control of intravenous anesthesia or sedation in patients presenting with co-morbidities or during major surgeries and show that cortical electrical activity represents a surrogate measure of hypnosis and analgesia depth. Currently all studies demonstrate that the use of automated control is potentially beneficial for the patient and that intermediate variables are improved by automated control.<br>
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