Wu EB, Lin YH, Yang JCS, Lai CW, Chin JC, Wu SC. Density Spectral Array Enables Precise Sedation Control for
Supermicrosurgical Lymphaticovenous Anastomosis: A Retrospective Observational Cohort Study.
Bioengineering (Basel) 2023;
10:bioengineering10040494. [PMID:
37106682 PMCID:
PMC10135781 DOI:
10.3390/bioengineering10040494]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Supermicrosurgical lymphaticovenous anastomosis (LVA) is a minimally invasive surgical technique that creates bypasses between lymphatic vessels and veins, thereby improving lymphatic drainage and reducing lymphedema. This retrospective single-center study included 137 patients who underwent non-intubated LVA in southern Taiwan. A total of 119 patients were enrolled and assigned to two study groups: the geriatric (age ≥ 75 years, n = 23) and non-geriatric groups (age < 75 years, n = 96). The primary outcome was to investigate and compare the arousal and maintenance of the propofol effect-site concentration (Ce) using an electroencephalographic density spectral array (EEG DSA) in both groups. The results showed that the geriatric group required less propofol (4.05 [3.73-4.77] mg/kg/h vs. 5.01 [4.34-5.92] mg/kg/h, p = 0.001) and alfentanil (4.67 [2.53-5.82] μg/kg/h vs. 6.68 [3.85-8.77] μg/kg/h, p = 0.047). The median arousal Ce of propofol among the geriatric group (0.6 [0.5-0.7] μg/mL) was significantly lower than that in patients aged ≤ 54 years (1.3 [1.2-1.4] μg/mL, p < 0.001), 55-64 years (0.9 [0.8-1.0] μg/mL, p < 0.001), and <75 years (0.9 [0.8-1.2] μg/mL, p < 0.001). In summary, the combined use of EEG DSA provides the objective and depth of adequate sedation for extensive non-intubated anesthesia in late-elderly patients who undergo LVA without perioperative complications.
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