Satomoto Maiko, Aoki Hiroshi, Tobita Morikuni, Shiohara Nao, Adachi Yushi, Higuchi Hideyuki, Watanabe Kazuhiko, Satoh Tetsuo
Medical Corps, 1st Air Wings, Japan Air Self Defense Force, Hamamatsu 432-8554.
Masui. 2003 May;52(5):527-9.
We report 3 patients who developed a sudden unpredicted increase in bispectral index (BIS) value during propofol and fentanyl anesthesia. The patients were induced with propofol 2-mg.kg-1 and fentanyl 2-micrograms.kg-1 and muscle relaxation was obtained by vecuronium 0.12-mg.kg-1. During induction of anesthesia, BIS value went down to below 50 in all three cases, and anesthesia was maintained by continuous infusion of propofol at a rate of 5 mg.kg-1.hr-1 and intermittent administration of fentanyl. Forty to sixty min after starting the operation, BIS value increased suddenly (up to 80) and the body movement of the patients was observed. The serum concentration of propofol was approximately 2.5 micrograms.ml-1. All patients were successfully treated with increasing the infusion rate of propofol and additional administration of fentanyl. No clear recall or explicit memory during operation was observed after anesthesia, but, anesthesiologists might have to pay more attention to unpredictable changes of anesthetic depth during propofol anesthesia using target controlled infusion.
我们报告了3例在丙泊酚和芬太尼麻醉期间双谱指数（BIS）值突然意外升高的患者。患者静脉注射2mg/kg丙泊酚和2μg/kg芬太尼诱导麻醉，并用0.12mg/kg维库溴铵实现肌肉松弛。在麻醉诱导期间，所有3例患者的BIS值均降至50以下，麻醉维持采用以5mg·kg-1·h-1的速率持续输注丙泊酚并间断给予芬太尼。手术开始40至60分钟后，BIS值突然升高（高达80），并观察到患者身体出现移动。此时丙泊酚的血清浓度约为2.5μg/ml。所有患者通过增加丙泊酚输注速率并额外给予芬太尼均成功得到治疗。麻醉后未观察到术中明确记忆或显性记忆，但麻醉医生在使用靶控输注进行丙泊酚麻醉期间可能需要更加关注麻醉深度的不可预测变化。
