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

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.