Gurman G M, Popescu M, Weksler N, Steiner O, Avinoah E, Porath A
Division of Anaesthesiology, Soroka Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Acta Anaesthesiol Scand. 2003 Aug;47(7):804-8. doi: 10.1034/j.1399-6576.2003.00148.x.
The objective of anaesthesia is to provide hypnosis, analgesia and adequate conditions during surgery. It is difficult to establish the appropriate dose of general anaesthetic drugs in the morbidly obese patient. Moreover, there are conflicting data concerning adequate anaesthesia levels and the severity of postoperative pain. The aim of this study was to investigate the relationship between the spectral edge frequency (SEF) during general anaesthesia and the severity of immediate postoperative pain following gastric banding surgery in morbidly obese patients.
Seventy-one ASA 2 morbidly obese patients (BMI > 35%) undergoing elective laparoscopic gastric banding procedure were recruited for this study. Anaesthesia consisted of midazolam, fentanyl and thiopental for induction, vecuronium for muscle relaxation, N2O and isoflurane with additional fentanyl administrations, according to the clinical judgement of the anaesthesiologist, for maintenance. Continuous SEF monitoring was added to the standard monitors (SpO2, ETCO2, ECG, NIBP, O2 and isoflurane concentration), but the EEG monitor screen was hidden from the anaesthesiologist's sight. SEF postoperative analysis divided the patients into two groups: group 1, SEF-recommended target range of 8-12 Hz, more than 80% of the surgical time; and group 2, SEF-recommended target range of 8-12 Hz, less than 80% of the surgery duration. Pain intensity was assessed in the post anaesthesia care unit using a standard visual analogue scale (VAS) of 10 cm, when patients were awake enough to correct a deliberately given wrong own telephone or ID number. Intravenous morphine was administered for postoperative analgesia in 2-mg increments, every 3-4 min, until the patient felt comfortable. A recovery room nurse unaware of the SEF range recorded during surgery registered pain severity and morphine requirements.
The end-tidal isoflurane concentration was significantly higher in group 1 than in group 2 (0.83 vs. 0.7 P = 0.016). The intensity of pain at admission into the recovery room and at discharge was significantly lower in group 1 than in group 2 (VAS 6.1 vs. 6.9-P = 0.0049, and 3.9 vs. 4.2-P = 0.00478, respectively).
Keeping the SEF range between 8 and 12 Hz during anaesthesia for laparoscopic gastric banding for morbid obesity, both the immediate post operative pain intensity and morphine requirement, are significantly reduced.
麻醉的目的是在手术期间提供催眠、镇痛和适当的条件。在病态肥胖患者中确定合适剂量的全身麻醉药物很困难。此外，关于适当的麻醉水平和术后疼痛的严重程度的数据相互矛盾。本研究的目的是调查病态肥胖患者在全身麻醉期间的频谱边缘频率（SEF）与胃束带手术后即刻术后疼痛严重程度之间的关系。
本研究招募了71例接受择期腹腔镜胃束带手术的ASA 2级病态肥胖患者（BMI>35%）。麻醉诱导采用咪达唑仑、芬太尼和硫喷妥钠，肌肉松弛采用维库溴铵，维持麻醉根据麻醉医生的临床判断采用N2O和异氟烷，并额外给予芬太尼。在标准监测仪（SpO2、ETCO2、ECG、NIBP、O2和异氟烷浓度）的基础上增加了连续SEF监测，但脑电图监测仪屏幕对麻醉医生隐藏。术后SEF分析将患者分为两组：第1组，SEF推荐目标范围为8 - 12Hz，手术时间超过80%；第2组，SEF推荐目标范围为8 - 12Hz，手术持续时间小于80%。当患者清醒到足以纠正故意给出的错误自己的电话号码或身份证号码时，在麻醉后护理单元使用10cm的标准视觉模拟量表（VAS）评估疼痛强度。术后镇痛静脉注射吗啡，每3 - 4分钟递增2mg，直到患者感觉舒适。一名不了解手术期间记录的SEF范围的恢复室护士记录疼痛严重程度和吗啡需求量。
第1组的呼气末异氟烷浓度显著高于第2组（0.83对0.7，P = 0.016）。第1组进入恢复室时和出院时的疼痛强度显著低于第2组（VAS分别为6.1对6.9，P = 0.0049；3.9对4.2，P = 0.00478）。
对于病态肥胖患者的腹腔镜胃束带手术麻醉期间，将SEF范围保持在8至12Hz之间，术后即刻疼痛强度和吗啡需求量均显著降低。
