• Merel H Kuizenga, VereeckeHugo E MHEMDepartment of Anaesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Anaesthesia and Reanimation, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium., Anthony R Absalom, Christian H Bucher, Laura N Hannivoort, Johannes P van den Berg, Livia Schmalz, StruysMichel M R FMMRFDepartment of Anaesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands., and Martin Luginbühl.
• Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: m.h.kuizenga@umcg.nl.
• Br J Anaesth. 2022 Jun 1; 128 (6): 959-970.

BackgroundThe advisory system SmartPilot® View (Drägerwerk AG, Lübeck, Germany) provides real-time, demographically adjusted pharmacodynamic information throughout anaesthesia, including time course of effect-site concentrations of administered drugs and a measure of potency of the combined drug effect termed the "'Noxious Stimulation Response Index' (NSRI). This dual-centre, prospective, observational study assesses whether the availability of SmartPilot® View alters the behaviour of anaesthetic drug titration of anaesthetists and improves the Anaesthesia Quality Score (AQS; percentage of time spent with MAP 60-80 mm Hg and Bispectral Index [BIS] 40-60 [blinded]).MethodsWe recruited 493 patients scheduled for elective surgery in two university centres. A control group (CONTROL; n=170) was enrolled to observe drug titration in current practice. Thereafter, an intervention group was enrolled, for which SmartPilot® View was made available to optimise drug titration (SPV; n=188). The AQS, haemodynamic and hypnotic effects, recovery times, pain scores, and other parameters were compared between groups.ResultsThere were 358 patients eligible for analysis. Anaesthesia quality score was similar between CONTROL and SPV (median AQS [Q1-Q3]) 25.3% [7.4-41.5%] and 22.2% [8.0-44.4%], respectively; P=0.898). Compared with CONTROL, SPV patients had less severe hypotension and hypertension, less BIS <40, faster tracheal extubation, and lower early postoperative pain scores.ConclusionsAdding SmartPilot® View information did not affect average drug titration behaviour. However, small improvements in control of MAP and BIS and early recovery suggest improved titration for some patients without increasing the risk of overdosing or underdosing.Clinical Trial RegistrationNCT01467167.Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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