使用施奈德药代动力学模型进行丙泊酚靶控输注期间的脑电双频指数-听觉诱发电位指数及临床指标

BIS - AAI and clinical measures during propofol target controlled infusion with Schnider's pharmacokinetic model.

作者信息

Iannuzzi E, Iannuzzi M, Viola G, Sidro L, Cardinale A, Chiefari M

机构信息

Department of Anesthesiological, Surgical and Emergency Sciences, Unit of Anesthesia and Intensive Care Medicine 2nd Service of Anaesthesia, 2nd University of Naples, Naples, Italy.

出版信息

Minerva Anestesiol. 2007 Jan-Feb;73(1-2):23-31.

PMID:17115013

Abstract

AIM

The A-line autoregressive index (AAI) and the Bispectral Index Score (BIS) are two commercially available indexes of anesthetic depth widely used in clinical practice. The aim of the current study was to compare the accuracy of AAI, BIS, Schnider's predicted effect-site concentration of propofol (Ce propofol) to assess depth of anesthesia.

METHODS

Forty-four patients scheduled for major elective abdominal surgery received target effect-site controlled infusion of propofol. Target effect-site (Ce propofol) was started at 1.5 mug/mL and increased every 4 min by 1.0 microg/mL until 5.5 microg/mL were achieved. At every step sedation level was estimated, using AAI, BIS, Observer's Assessment of Alertness/Sedation scale (OAA/S), loss of eyelash reflex and Ce propofol.

RESULTS

We enrolled 44 patients, 20 males and 24 females, ASA I/II 18/26, 48+/-10 years, 68.2+/-9 kg, 165+/-7.1 cm, body mass index (BMI) 25+/-3.5. At increasing Ce propofol BIS-AAI values decreased progressively (BIS range 97-38) (AAI range 97-17). Values of BIS < or = 50, of AAI < or = 48 and of Ce propofol > or = 5.1 resulted in OAA/S=0, while values of BIS < or = 62, AAI < or = 53 and Ce propofol < or = 3.5 resulted in OAA/S=2. Loss of eyelash reflex occurred when values were BIS < or = 64 and AAI < or 61.

CONCLUSION

BIS, AAI, propofol site effect concentration revealed information on sedation level and consciousness but no gold standard yet exists because of consistent overlap between ''conscious'' and ''not conscious'' states.

摘要

目的

A线自回归指数（AAI）和脑电双频指数（BIS）是临床上广泛应用的两种麻醉深度商业指标。本研究旨在比较AAI、BIS和施奈德丙泊酚效应室预测浓度（Ce丙泊酚）评估麻醉深度的准确性。

方法

44例择期行腹部大手术的患者接受丙泊酚效应室靶控输注。效应室靶浓度（Ce丙泊酚）起始为1.5μg/mL，每4分钟增加1.0μg/mL，直至达到5.5μg/mL。在每一步，使用AAI、BIS、观察者警觉/镇静评分量表（OAA/S）、睫毛反射消失情况和Ce丙泊酚评估镇静水平。

结果

我们纳入了44例患者，其中男性20例，女性24例，美国麻醉医师协会（ASA）分级I/II级分别为18/26例，年龄48±10岁，体重68.2±9kg，身高165±7.1cm，体重指数（BMI）25±3.5。随着Ce丙泊酚浓度增加，BIS-AAI值逐渐降低（BIS范围97 - 38）（AAI范围97 - 17）。BIS≤50、AAI≤48且Ce丙泊酚≥5.1时，OAA/S = 0；而BIS≤62、AAI≤53且Ce丙泊酚≤3.5时，OAA/S = 2。当BIS≤64且AAI＜61时出现睫毛反射消失。