丙泊酚-瑞芬太尼麻醉期间Alaris听觉诱发电位指数与脑电双频指数的比较

Comparison of Alaris AEP index and bispectral index during propofol-remifentanil anaesthesia.

作者信息

Kreuer S, Bruhn J, Larsen R, Hoepstein M, Wilhelm W

机构信息

Department of Anaesthesiology and Intensive Care Medicine, University of Saarland, D-66421 Homburg/Saar, Germany.

出版信息

Br J Anaesth. 2003 Sep;91(3):336-40. doi: 10.1093/bja/aeg189.

DOI:10.1093/bja/aeg189

PMID:12925470

Abstract

BACKGROUND

The Alaris AEP monitor(TM) (Alaris, UK, version 1.4) is the first commercially available auditory evoked potential (AEP) monitor designed to estimate the depth of anaesthesia. It generates an "Alaris AEP index" (AAI), which is a dimensionless number scaled from 100 (awake) to 0. This study was designed to compare AAI and BIS(TM) (Aspect, USA, version XP) values at different levels of anaesthesia.

METHODS

Adult female patients were premedicated with diazepam 0.15 mg kg(-1) orally on the morning of surgery. Electrodes for BIS and Alaris AEP monitoring and a headphone to give auditory stimuli were applied as recommended by the manufacturers. Anaesthesia was induced with remifentanil (0.4 microg kg(-1) min(-1)) and a propofol target-controlled infusion (Diprifusor(TM) TCI, AstraZeneca, Germany) to obtain a predicted concentration of initially 3.5 microg ml(-1). After loss of consciousness the patients were given 0.5 mg kg(-1) of atracurium. After tracheal intubation, remifentanil was given at 0.2 microg kg(-1) min(-1) and the propofol infusion was adjusted to obtain BIS target values of 30, 40, 50, and 60. AAI and BIS values were recorded and matched with the predicted propofol effect-site concentrations. Prediction probability was calculated for consciousness vs unconsciousness. Values are mean (SD).

RESULTS

Fifty female patients, 53 (15), range 18-78 yr, ASA I or II were studied. Mean values before induction of anaesthesia were 95 (4), range 99-82 for BIS and 85 (12), range 99-55 for AAI. With loss of eyelash reflex both values were significantly reduced to 64 (13), range 83-39 for BIS (P<0.05) and 61 (22), range 99-15 for AAI (P<0.05). The prediction probability P(K) for consciousness vs unconsciousness (i.e. loss of eyelash reflex) was better for BIS (P(K)=0.99) than for AAI (P(K)=0.79). At a BIS of 30, 40, 50, and 60 the corresponding AAI values were 15 (6), 20 (8), 28 (11), and 40 (16), and these were significantly different.

CONCLUSIONS

During propofol-remifentanil anaesthesia a decrease of the depth of anaesthesia as indicated by BIS monitoring is accompanied by corresponding effects shown by the AAI. However, wide variation in the awake values and considerable overlap of AAI values between consciousness and unconsciousness, suggests further improvement of the AAI system is required.

摘要

背景

阿拉瑞斯听觉诱发电位监测仪（Alaris AEP monitor™）（英国阿拉瑞斯公司，1.4版本）是首款用于估计麻醉深度的商用听觉诱发电位（AEP）监测仪。它生成一个“阿拉瑞斯听觉诱发电位指数”（AAI），这是一个无量纲数字，范围从100（清醒）到0。本研究旨在比较不同麻醉水平下的AAI和脑电双频指数（BIS™）（美国Aspect公司，XP版本）值。

方法

成年女性患者在手术当天早晨口服0.15 mg·kg⁻¹地西泮进行术前用药。按照制造商的建议，应用用于BIS和阿拉瑞斯听觉诱发电位监测的电极以及用于给予听觉刺激的耳机。使用瑞芬太尼（0.4 μg·kg⁻¹·min⁻¹）和丙泊酚靶控输注（德国阿斯利康公司的得普利麻™ TCI）诱导麻醉，以获得初始预测浓度为3.5 μg/ml。意识消失后，给予患者0.5 mg·kg⁻¹阿曲库铵。气管插管后，以0.2 μg·kg⁻¹·min⁻¹给予瑞芬太尼，并调整丙泊酚输注以获得BIS目标值30、40、50和60。记录AAI和BIS值，并与预测的丙泊酚效应室浓度进行匹配。计算意识与无意识状态下的预测概率。数值为平均值（标准差）。

结果

研究了50例年龄53（15）岁、范围在18 - 78岁、美国麻醉医师协会（ASA）分级为I或II级的女性患者。麻醉诱导前BIS的平均值为95（4），范围在99 - 82；AAI的平均值为85（12），范围在99 - 55。睫毛反射消失时，两个值均显著降低，BIS降至64（13），范围在83 - 39（P<0.05），AAI降至61（22），范围在99 - 15（P<0.05）。意识与无意识状态（即睫毛反射消失）的预测概率P(K)，BIS（P(K)=0.99）优于AAI（P(K)=0.79）。当BIS为30、40、50和60时，相应的AAI值分别为15（6）、20（8）、28（11）和40（16），且这些值有显著差异。