Mi W D, Sakai T, Singh H, Kudo T, Kudo M, Matsuki A
Department of Anaesthesiology, University of Hirosaki School of Medicine, Japan.
Eur J Anaesthesiol. 1999 Jan;16(1):47-52. doi: 10.1046/j.1365-2346.1999.00421.x.
Hypnotic endpoints and/or EEG variables, e.g. bispectral index, 95% spectral edge frequency and median frequency, have been studied to monitor anaesthetic (hypnotic) depth during total intravenous anaesthesia. In this study, the relation between the hypnotic endpoints of unresponsiveness to verbal commands, loss of eyelash reflex and body movement response to mechanical nasal membrane stimulation vs. bispectral index, 95% spectral edge frequency and median frequency during propofol anaesthesia with or without fentanyl is presented. Forty-two patients were randomly assigned to receive either propofol infusion, 30 mg kg-1 h-1 (n = 22), or propofol infusion, 30 mg kg-1 h-1 + fentanyl bolus, 2 micrograms kg-1 i.v. (n = 20). Bispectral index, 95% spectral edge frequency and median frequency and propofol doses were monitored and recorded at unresponsiveness to verbal commands, loss of eyelash reflex and inhibition of nasal body movement response. The bispectral index values were significantly higher in the propofol + fentanyl compared with the propofol group, i.e. 74.7 +/- 10.9, 73.1 +/- 10.5 and 47.1 +/- 9.2 vs. 65.8 +/- 9.8, 59.6 +/- 10 and 33.8 +/- 5.7 at unresponsiveness to verbal commands, loss of eyelash reflex and inhibition of nasal body movement response respectively. Doses of propofol for achieving the hypnotic endpoints were significantly lower in the propofol + fentanyl compared with the propofol group. Plasma propofol concentrations at inhibition of nasal body movement response were lower in the propofol + fentanyl compared with the propofol group (9.2 +/- 2.0 micrograms mL-1 vs. 14.1 +/- 4.2 micrograms mL-1). Our results suggest that fentanyl pretreatment potentiates the effects of propofol and achieves the hypnotic endpoints at higher bispectral index values and lower propofol doses and concentrations (measured at inhibition of nasal body movement response).
已经对催眠终点和/或脑电图变量，如脑电双频指数、95%频谱边缘频率和中位数频率进行了研究，以监测全静脉麻醉期间的麻醉（催眠）深度。在本研究中，呈现了在丙泊酚麻醉（有或没有芬太尼）期间，对言语指令无反应、睫毛反射消失和对机械性鼻黏膜刺激的身体运动反应等催眠终点与脑电双频指数、95%频谱边缘频率和中位数频率之间的关系。42例患者被随机分配接受丙泊酚输注，30mg·kg-1·h-1（n = 22），或丙泊酚输注，30mg·kg-1·h-1 + 芬太尼推注，2μg·kg-1静脉注射（n = 20）。在对言语指令无反应、睫毛反射消失和鼻身体运动反应受抑制时，监测并记录脑电双频指数、95%频谱边缘频率和中位数频率以及丙泊酚剂量。与丙泊酚组相比，丙泊酚 + 芬太尼组的脑电双频指数值显著更高，即在对言语指令无反应、睫毛反射消失和鼻身体运动反应受抑制时，分别为74.7±10.9、73.1±10.5和47.1±9.2，而丙泊酚组分别为65.8±9.8、59.6±10和33.8±5.7。与丙泊酚组相比，丙泊酚 + 芬太尼组达到催眠终点所需的丙泊酚剂量显著更低。在鼻身体运动反应受抑制时，丙泊酚 + 芬太尼组的血浆丙泊酚浓度低于丙泊酚组（9.2±2.0μg·mL-1对14.1±4.2μg·mL-1）。我们的结果表明，芬太尼预处理增强了丙泊酚的作用，并在更高的脑电双频指数值和更低的丙泊酚剂量及浓度（在鼻身体运动反应受抑制时测量）下达到催眠终点。
