Irvine, California-based Masimo’s study investigated the impact of anesthesia during cardiac surgery guided by SedLine monitoring. The company published the findings in the Journal of Cardiothoracic and Vascular Anesthesia.
According to a news release, Dr. André Denault and colleagues at the Montreal Heart Institute and Centre Hospitalier de l’Université de Montréal studied the use of SedLine’s processed electroencephalography (pEEG) feature, the Patient State Index (PSi). Masimo said the study is the first to primarily explore the impact of pEEG-guided anesthesia on vasoactive and inotropic drugs.
The study’s findings demonstrated that pEEG-guided anesthesia was associated with a reduction in the use of such drugs along with less use of anesthetic agents and opioids in the OR. It also led to lower central venous pressure (CVP), less fluid administration, less intraoperative bleeding and shorter duration on mechanical ventilation.
Researchers’ primary goal was to determine whether pEEG-guided anesthesia would be associated with reduced hemodynamic instability during cardiopulmonary bypass (CPB) separation. The secondary goal was to determine if pEEG-guided anesthesia would lead to the hypothesized reduction in vasoactive and inotropic drug administration in the ICU.
In a retrospective cohort of 300 adult patients who underwent cardiac surgery using CPB between 2013 and 2020 at the Montreal Heart Institute, two groups were divided based on whether anesthesia was guided by pEEG, which became a standard of care in 2017. Patients in the pEEG group (150 total) were monitored using Masimo SedLine.
Patients in the pEEG group received fewer vasoactive and inotropic drugs in the first hour after ICU admission. Several additional outcomes, including duration of mechanical ventilation, intraoperative fluid balance and the amount of bleeding came through in the pEEG group.
While a lower proportion of patients experienced unsuccessful CPB separation in the pEEG group compared to the control, after adjustments for other parameters, use of pEEG-guided anesthesia was not independently associated with successful CPB separation. Researchers noted that unsuccessful separation was associated with several independent known predictors of hemodynamic complications.
“pEEG-guided anesthesia is associated with a reduction in the use of inotropic or vasoactive drugs at arrival in the ICU,” the researchers said in the release. “In addition, its implementation was associated with lower requirements of anesthetic agents and opioids in the OR, lower CVP, fluid requirements, intraoperative bleeding, and shorter duration of mechanical ventilation. However, its use did not facilitate weaning from CPB compared to a group where pEEG was unavailable. Future research is needed to confirm these results in prospective randomized clinical trials.”