Koitabashi Toshiya, Johansen Jay W, Sebel Peter S
Ichikawa General Hospital, Tokyo Dental College, Tokyo, Japan.
Anesth Analg. 2002 Jun;94(6):1530-3, table of contents. doi: 10.1097/00000539-200206000-00028.
The effect of opioid administration on the bispectral index (BIS) during general anesthesia is controversial. Several investigators have reported BIS to be insensitive to opioid addition, whereas others have found a hypnotic response. We designed this study to examine the effect of remifentanil on BIS during combined regional/general propofol anesthesia under steady-state conditions. After Human Investigations Committee approval, 19 healthy ASA physical status I or II patients were enrolled in a prospective experimental design. Regional anesthesia was initiated and general anesthesia induced by using computer-assisted continuous infusion of propofol. Propofol was incrementally adjusted to a BIS of approximately 60. After 20 min at a stable propofol infusion rate, a remifentanil computer-assisted continuous infusion (effect-site target concentration of 0.5, 2.5, and then 10 ng/mL) was sequentially administered at stepped 15-min intervals. BIS decreased from 56 +/- 2 to 44 +/- 1, 95% spectral edge frequency from 17.9 +/- 0.5 Hz to 15.0 +/- 0.4 Hz, heart rate from 84 +/- 5 bpm to 62 +/- 4 bpm, and mean arterial blood pressure from 93 +/- 4 mm Hg to 69 +/- 3 mm Hg with increasing remifentanil concentration. A significant linear correlation between BIS, 95% spectral edge frequency, heart rate, and log (remifentanil effect-site) concentration was found. The change in baseline BIS was relatively modest but significant, suggesting that remifentanil has some sedative/hypnotic properties, or that it potentiates the hypnotic effect of propofol.
This experiment identified a significant, dose-dependent decrease in bispectral index (BIS), 95% spectral edge frequency, heart rate, and mean arterial blood pressure with increasing remifentanil dose. The change in baseline BIS was relatively modest but significant, suggesting that remifentanil has some sedative/hypnotic properties, or that it potentiates the hypnotic effect of propofol.
全身麻醉期间使用阿片类药物对脑电双频指数（BIS）的影响存在争议。一些研究者报告称BIS对添加阿片类药物不敏感，而另一些人则发现有催眠反应。我们设计了这项研究，以检查在稳态条件下，瑞芬太尼对区域/全身联合丙泊酚麻醉期间BIS的影响。经人体研究委员会批准，19例美国麻醉医师协会（ASA）身体状况为I或II级的健康患者纳入前瞻性实验设计。开始实施区域麻醉，并通过计算机辅助持续输注丙泊酚诱导全身麻醉。丙泊酚逐渐调整至BIS约为60。在丙泊酚输注速率稳定20分钟后，以15分钟的间隔逐步依次给予瑞芬太尼计算机辅助持续输注（效应室靶浓度为0.5、2.5，然后是10 ng/mL）。随着瑞芬太尼浓度增加，BIS从56±2降至44±1，95%频谱边缘频率从17.9±0.5 Hz降至15.0±0.4 Hz，心率从84±5次/分钟降至62±4次/分钟，平均动脉血压从93±4 mmHg降至69±3 mmHg。发现BIS、95%频谱边缘频率、心率与瑞芬太尼效应室浓度的对数之间存在显著的线性相关性。基线BIS的变化相对较小但具有显著性，表明瑞芬太尼具有一定的镇静/催眠特性，或者它增强了丙泊酚的催眠效果。
本实验发现随着瑞芬太尼剂量增加，脑电双频指数（BIS）、95%频谱边缘频率、心率和平均动脉血压显著降低，且呈剂量依赖性。基线BIS的变化相对较小但具有显著性，表明瑞芬太尼具有一定的镇静/催眠特性，或者它增强了丙泊酚的催眠效果。
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