Nishihara Fumio, Saito Shigeru
Department of Anesthesiology & Reanimatology, Gunma University School of Medicine, Maebashi, Japan.
Anesth Analg. 2002 May;94(5):1249-52, table of contents. doi: 10.1097/00000539-200205000-00037.
Propofol anesthesia increases the seizure threshold of patients receiving electroconvulsive therapy. Excessive neuronal suppression could result in an unacceptably short seizure. We sought to identify the correlation between the pre-ictal bispectral index (BIS) score and seizure duration in patients receiving electroconvulsive therapy under propofol anesthesia. BIS was monitored in 38 psychotically depressed patients. Anesthesia was induced by a bolus injection of 1 mg/kg of propofol. The duration of muscular and electroencephalographic seizure was measured during the therapy. The BIS immediately before the electrical shock was 54 +/- 13. Both muscular and electroencephalographic seizure durations had a positive correlation with pre-ictal BIS (r = 0.68 and 0.73, respectively; P < 0.01). After the electrically induced seizure, BIS decreased to 30 +/- 8, reflecting post-ictal suppression. BIS scores when the patients had awakened after the seizure had a wide variation (range, 29-81; mean, 45; SD, 13). In conclusion, seizure duration has a positive correlation with BIS immediately before electrical shock; however, BIS may not be an accurate predictor of awakening after electrical shock.
Pre-ictal bispectral index had a positive correlation with seizure duration and could be useful to prevent an unacceptably short seizure in electroconvulsive therapy under propofol anesthesia.
丙泊酚麻醉可提高接受电休克治疗患者的癫痫发作阈值。过度的神经元抑制可能导致癫痫发作时间过短而无法接受。我们试图确定在丙泊酚麻醉下接受电休克治疗的患者发作前双谱指数（BIS）评分与癫痫发作持续时间之间的相关性。对38例精神病性抑郁症患者进行了BIS监测。通过静脉推注1mg/kg丙泊酚诱导麻醉。在治疗期间测量肌肉和脑电图癫痫发作的持续时间。电击前的BIS为54±13。肌肉和脑电图癫痫发作持续时间与发作前BIS均呈正相关（分别为r = 0.68和0.73；P < 0.01）。电诱发癫痫发作后，BIS降至30±8，反映发作后抑制。癫痫发作后患者苏醒时的BIS评分差异很大（范围为29 - 81；平均值为45；标准差为13）。总之，癫痫发作持续时间与电击前的BIS呈正相关；然而，BIS可能不是电击后苏醒的准确预测指标。
发作前双谱指数与癫痫发作持续时间呈正相关，对于预防丙泊酚麻醉下电休克治疗中癫痫发作时间过短可能有用。
