Intraoperative monitoring of sedation and analgesia in patients over 70 years old in ENT surgery: a randomized prospective study

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OBJECTIVE

To analyze the effectiveness of EEG-based monitoring of anesthesia (qCON) and analgesia (qNOX) in older patients undergoing ENT surgery.

MATERIAL AND METHODS

A randomized prospective study included 66 patients (70—85 years old, ASA III-IV) who underwent ENT surgery. All ones were divided into 2 equal groups: group A — general anesthesia under CONOX monitoring, group B — standard monitoring. We estimated doses of propofol, fentanyl and sevoflurane, intraoperative hemodynamic profile, intraoperative awakening, postoperative nausea and vomiting (PONV), need for additional analgesia in early postoperative period.

RESULTS

The total amount of propofol for induction of anesthesia was lower in group A (1.6 [1.30—1.77] vs. 1.76 [1.54—1.90] mg/kg (p=0.016). Dose of fentanyl amounted to 1.92 [1.62—3.13] and 2.21 [1.35—3.71] µg/kg/hour, respectively (p=0.672). Dose of sevoflurane was similar in both groups. Intraoperative hemodynamic disorders requiring vasopressor and/or hypotonic drugs occurred in 3 (9%) and 6 (18%) patients, respectively. PONV developed in 3 (9%) and 6 (18%) patients, respectively. Intraoperative awakening was observed in 1 (3%) and 3 (9%) patients, respectively. In early postoperative period, 13 (39%) patients in each group complained of pain and needed for additional analgesia without between-group differences in these indicators.

CONCLUSION

EEG-based monitoring of anesthesia and analgesia in people over 70 years old undergoing ENT surgery is valuable to optimize doses of analgesics and hypnotics, reduce the incidence and severity of hemodynamic disturbances, intraoperative awakening and PONV.

Keywords:

anesthesia

intraoperative monitoring

ENT

geriatrics

Authors:

Altoufaili M.H.

National Medical Research Center for Otorhinolaryngology

ORCID: 0000-0002-6837-8101

Klypa T.V.

Federal Scientific Clinical Center for Specialized Types of Medical Care and Medical Technologies

SPIN RSCI: 2349-8980
Scopus AuthorID: 22835146300
ORCID: 0000-0002-2732-967X

Ryazanov V.B.

National Medical Research Center for Otorhinolaryngology

ORCID: 0000-0002-3890-0472

Mandel I.A.

Federal Scientific Clinical Center for Specialized Types of Medical Care and Medical Technologies;
Sechenov First Moscow State Medical University

ORCID: 0000-0001-9437-6591

Received:

02.10.2023

Accepted:

28.02.2024

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