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Effect of ketamine on the NeuroSENSE WAVCNS during propofol anesthesia; a randomized feasibility trial

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Abstract

Dose-dependent effects of ketamine on processed electroencephalographic depth-of-hypnosis indices have been reported. Limited data are available for the NeuroSENSE WAVCNS index. Our aim was to establish the feasibility of closed-loop propofol-remifentanil anesthesia guided by the WAVCNS index in the presence of an analgesic dose of ketamine. Thirty ASA I-II adults, 18–54 years, requiring general anesthesia for anterior cruciate ligament surgery were randomized to receive: full-dose [ketamine, 0.5 mg kg−1 initial bolus, 10 mcg kg−1 min−1 infusion] (recommended dose for postoperative pain management); half-dose [ketamine, 0.25 mg kg−1 bolus, 5 mcg kg−1 min−1 infusion]; or control [no ketamine]. After the ketamine bolus, patients received 1.0 mcg kg−1 remifentanil over 30 s, then 1.5 mg kg−1 propofol over 30 s, followed by manually-adjusted propofol-remifentanil anesthesia. The WAVCNS was > 60 for 7/9 patients in the full-dose group at 7 min after starting the propofol infusion. This was inconsistent with clinical observations of depth-of-hypnosis and significantly higher than control (median difference [MD] 17.0, 95% confidence interval [CI] 11.4–26.8). WAVCNS was median [interquartile range] 49.3 [42.2–62.6] in the half-dose group, and not different to control (MD 5.1, 95% CI − 4.9 to 17.9). During maintenance of anesthesia, the WAVCNS was higher in the full-dose group compared to control (MD 14.7, 95% CI 10.2–19.2) and in the half-dose group compared to control (MD 11.4, 95% CI 4.7–20.4). The full-dose of ketamine recommended for postoperative pain management had a significant effect on the WAVCNS. This effect should be considered when using the WAVCNS to guide propofol-remifentanil dosing.

Trial Registration ClinicalTrails.gov No. NCT02908945.

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Acknowledgements

The authors would like to thank the anesthesiologists, surgeons, operating room staff, post-anesthetic care unit nurses, and surgical day care nurses at the Eagle Ridge Hospital for their interest and willingness to support study procedures, and the patients for their participation in the study.

Funding

This study was supported by internal funds. NeuroWave Systems Inc. provided loan equipment and sensors for this study.

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Authors and Affiliations

  1. Department of Electrical and Computer Engineering, UBC, Vancouver, BC, Canada

    Klaske van Heusden & Guy A Dumont

  2. Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia (UBC), Vancouver, BC, Canada

    Erin Cooke, Sonia Brodie, Nicholas West, Matthias Görges, J Mark Ansermino & Richard N Merchant

  3. Research Institute, BC Children’s Hospital, Vancouver, BC, Canada

    Klaske van Heusden, Erin Cooke, Matthias Görges, Guy A Dumont & J Mark Ansermino

  4. Department of Anesthesia, Royal Columbian Hospital, Fraser Health Authority, New Westminster, BC, Canada

    Richard N Merchant

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  1. Klaske van Heusden
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  2. Erin Cooke
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  3. Sonia Brodie
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  4. Nicholas West
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  5. Matthias Görges
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  6. Guy A Dumont
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  8. Richard N Merchant
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Contributions

KvH contributed to study design and data analysis. EC contributed to study design, patient recruitment, data collection, and data analysis. SB contributed to study design and data analysis. NW contributed to data analysis. MG contributed to study design and data analysis. GAD contributed to study design. JMA contributed to study design. RNM contributed to study design and data collection. All authors contribution to manuscript preparation.

Corresponding author

Correspondence to Klaske van Heusden.

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Conflict of interest

GAD is a co-inventor of the NeuroSENSE monitor (NeuroWave Systems Inc., Cleveland, OH), GAD and JMA have consulted for NeuroWave Systems Inc. KvH, MG, GAD, JMA, and RNM are party to a licensing agreement between UBC and NeuroWave Systems Inc. for control technology. GAD, JMA, and RNM have received funds for research sponsored by NeuroWave Systems Inc. The remaining authors have no interests to declare.

Informed consent

Written informed consent was obtained from all individual participants in this study.

Research involving Human Participants

This study was conducted with research ethics board approval (Fraser Health Research Ethics Board, FHREB 2016-054).

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van Heusden, K., Cooke, E., Brodie, S. et al. Effect of ketamine on the NeuroSENSE WAVCNS during propofol anesthesia; a randomized feasibility trial. J Clin Monit Comput 35, 557–567 (2021). https://doi.org/10.1007/s10877-020-00511-0

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  • DOI: https://doi.org/10.1007/s10877-020-00511-0

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