Background: Titrating propofol administration using BIS reduces i

Background: Titrating propofol administration using BIS reduces its requirement and shortens the recovery from anesthesia in adults. However, there

is still mixed evidence for utility of anesthesia depth monitors in reducing anesthesia requirement in children.

Methods/Materials: A prospective randomized study was conducted in 50 ASA I children of 2-12 years, randomly assigned into standard practice (SP) or BIS group. After induction with propofol, anesthesia was maintained with 150 mu propofol infusion. The propofol infusion rate selleck compound was altered by 20 mu to maintain the systolic blood pressure within 20% of the baseline (SP group) or BIS value between 45 and 60 (BIS group). The rate of propofol infusion was reduced

by 50% about 15 min before the end of surgery. The amount of propofol used and the times from stopping the propofol infusion to eye opening, extubation, response to commands and attaining Steward score of 6 were recorded.

Results: There was no evidence of a difference in the mean propofol consumption in the two groups (BIS 232.6 +/- 136.7 mg, SP 250.8 +/- 118.2 mg). The intraoperative hemodynamics and BIS values were similar in the two groups. There was no evidence for a difference between groups in the mean times from termination of anesthetic to eye opening, extubation, response to commands and to achieve a Steward Recovery score of 6.

Conclusions: Our study showed no benefit of BIS-guided propofol administration on anesthetic consumption or recovery

compared to standard anesthetic practice.”
“Randomised controlled MK-0518 cell line trials (RCTs) in surgery are complex to design and conduct and face unique challenges compared to trials in other specialties. The appropriate selection, measurement and reporting of outcomes are one aspect that requires attention. Outcomes in surgical RCTs are often ill-defined, inconsistent and at high risk of bias in their assessment and historically, there has been an undue focus on short-term outcomes and adverse events meaning the value of trial results for clinical practice and decision-making is limited.

This review addresses three key problems with surgical trial outcomes-choosing the right outcomes for the trial design and purpose, selecting relevant outcomes to measure from the range of possible outcomes, and measuring outcomes with minimal risk of bias. Each obstacle is discussed in turn, highlighting some suggested solutions and current initiatives working towards improvements in these areas. Some examples of good practice in this field are also discussed.

Many of the historical problems with surgical trial outcomes may be overcome with an increased understanding of the trial design and purpose and recognition that pragmatic trials require assessments of outcomes that are patient-centred in addition to measurement of short-term outcomes.

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