De Baerdemaeker L E C, Struys M M R F, Jacobs S, Den Blauwen N M M, Bossuyt G R P J, Pattyn P, Mortier E P
Department of Anaesthesia, Ghent University Hospital, De Pintelaan 185, B-9000, Gent, Belgium.
Br J Anaesth. 2003 Nov;91(5):638-50. doi: 10.1093/bja/aeg236.
The concept of an 'inhalation bolus' can be used to optimize inhaled drug administration. We investigated the depth of anaesthesia, haemodynamic stability, and recovery time in morbidly obese patients resulting from bispectral index (BIS)-guided sevoflurane or desflurane administration and BIS-triggered inhalation boluses of sevoflurane or desflurane combined with titration of remifentanil.
Fifty morbidly obese patients undergoing laparoscopic gastroplasty received either BIS-guided sevoflurane or desflurane anaesthesia in combination with a remifentanil target-controlled infusion. Intraoperative haemodynamic stability and BIS control were measured. Immediate recovery was recorded.
Intraoperatively, the BIS was between 40 and 60 for a greater percentage of time in the sevoflurane (78 (13)% of case time) than in the desflurane patients (64 (14)% of case time), owing to too profound anaesthesia in the desflurane patients at the start of the procedure. However, fewer episodes of hypotension were found in the desflurane group, without the occurrence of more hypertensive episodes. During immediate recovery, eye opening, extubation, airway maintenance, and orientation occurred sooner in the desflurane group.
Immediate recovery was significantly faster in the desflurane group. Overall hypnotic controllability measured by BIS was less accurate with desflurane. Overall haemodynamic controllability was better when using desflurane. Fewer episodes of hypotension were found in the desflurane group. The use of the inhalation bolus was found to be appropriate in both groups without causing severe haemodynamic side effects. Minimal BIS values were significantly lower after a desflurane bolus.
“吸入团注”的概念可用于优化吸入药物给药。我们研究了病态肥胖患者在双谱指数（BIS）引导下使用七氟烷或地氟烷以及七氟烷或地氟烷的BIS触发吸入团注联合瑞芬太尼滴定给药时的麻醉深度、血流动力学稳定性和恢复时间。
50例接受腹腔镜胃成形术的病态肥胖患者接受BIS引导下的七氟烷或地氟烷麻醉，并联合瑞芬太尼靶控输注。术中测量血流动力学稳定性和BIS控制情况。记录即时恢复情况。
术中，七氟烷组（占病例时间的78（13）%）BIS在40至60之间的时间百分比高于地氟烷组（占病例时间的64（14）%），原因是地氟烷组在手术开始时麻醉过深。然而，地氟烷组低血压发作较少，且未出现更多高血压发作。在即时恢复期间，地氟烷组睁眼、拔管、气道维持和定向出现得更快。
地氟烷组的即时恢复明显更快。用地氟烷时，通过BIS测量的总体催眠可控性不太准确。使用地氟烷时，总体血流动力学可控性更好。地氟烷组低血压发作较少。发现两组使用吸入团注均合适，且未引起严重血流动力学副作用。地氟烷团注后最小BIS值显著更低。
