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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Hypnosis closed loop TCI systems in outpatient surgery
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Vol. 64. Issue 6.
Pages 323-327 (June - July 2017)
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Vol. 64. Issue 6.
Pages 323-327 (June - July 2017)
Brief Report
Hypnosis closed loop TCI systems in outpatient surgery
Sistemas de TCI en circuito cerrado para la hipnosis en cirugía ambulatoria
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2
A. Ramos-Luengo
Corresponding author
adrlue@yahoo.es

Corresponding author.
, F. Asensio-Merino
Servicio de Anestesia y Reanimación, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
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Table 1. Demographic characteristics, duration of surgery and outpatient surgery failure.
Abstract
Objective

Determine the influence of general anaesthesia with closed-loop systems in the results of outpatient varicose vein surgery.

Patients and methods

Retrospective observational study including data from 270 outpatients between 2014 and 2015. The patients were divided into 2 groups according to the type of general anaesthesia used. The CL Group included patients who received propofol in closed-loop guided by BIS and remifentanil using TCI, and the C Group received non-closed-loop anaesthesia. Age, sex, surgical time, discharge time and failure of outpatient surgery were recorded. Quantitative data were checked for normal distribution by the method of Kolmogorov–Smirnov–Lilliefors. Differences between groups were analysed by a Student-t-test or Mann–Whitney–Wilcoxon test, depending on their distribution. Categorical data were analysed by a Chi-squared test. We used Kaplan–Meier estimator and the effect size (calculated by Cohen's d) to study the discharge time. Statistical analysis was performed using R 3.2.3 binary for Mac OS×10.9.

Results

There were no significant differences in age, sex and surgical time and failure of outpatient surgery. Discharge time was different in both groups: 200 (100) vs. 180 (82.5)min, C Group and CL Group, respectively (data are median and interquartile rank); p=0.005.

Conclusion

The use of closed-loop devices for the hypnotic component of anaesthesia hastens discharge time. However, for this effect to be clinically significant, some improvements still need to be made in our outpatient surgery units.

Keywords:
Anaesthesia recovery period
Anaesthesia general
Ambulatory surgical procedures
Patient discharge
Resumen
Objetivo

Evaluar la influencia de los sistemas de circuito cerrado para anestesia general en los resultados de la cirugía de varices en régimen de cirugía mayor ambulatoria.

Pacientes y métodos

Estudio observacional retrospectivo en el que se incluyeron 270 pacientes entre los años 2014 y 2015. En el Grupo CL se incluyeron pacientes que recibieron propofol en asa cerrada guiada por BIS y remifentanilo en TCI. Y en el Grupo C, los que no recibieron una anestesia en circuito cerrado. La edad, el sexo, la duración de la cirugía, el tiempo de descarga y los fracasos en la ambulatorización fueron recogidos. Tras verificar el tipo de distribución mediante el test de Kolmogorov-Smirnov-Lilliefors, las variables cuantitativas fueron analizadas mediante el test de la t de Student o el de Mann-Whitney-Wilcoxon, según el caso. Las variables cualitativas fueron analizadas mediante el test de la Chi cuadrado. El tiempo de descarga fue además analizado mediante curvas de supervivencia (Kaplan-Meier) y se calculó el tamaño del efecto con la d de Cohen. El análisis estadístico se realizó utilizando software R 3.2.3 binary para Mac OS X 10.9.

Resultados

No se hallaron diferencias estadísticamente significativas salvo en los tiempos de descarga, que fueron menores en el Grupo CL: 200 (100) vs. 180 (82,5), p=0,005 (mediana y rango intercuartílico).

Conclusión

El uso de dispositivos de asa cerrada para el componente hipnótico de la anestesia reduce los tiempos de descarga. Pero se precisaría optimizar el funcionamiento de nuestra Unidad de Cirugía Mayor Ambulatoria para que la reducción fuese clínicamente relevante.

Palabras clave:
Periodo de recuperación anestésico
Anestesia general
Procedimientos quirúrgicos ambulatorios
Alta del paciente

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