Bould M D, Mahtani D G, Davies R, Roughton M, Hunter D N, Kelleher A
Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.
Anaesthesia. 2007 May;62(5):438-45. doi: 10.1111/j.1365-2044.2007.04986.x.
Rigid bronchoscopy is associated with a high incidence of haemodynamic disturbance and awareness under anaesthesia. Anaesthetic agents are given both to attenuate the sympathetic response to bronchoscopy and to prevent awareness. Use of the Bispectral index to guide anaesthesia has shown to reduce awareness and improve recovery times from general anaesthesia. We undertook a prospective observational study of BIS values in 50 patients during routine anaesthesia for rigid bronchoscopy. BIS values were found to be between 40-60 during bronchoscopy for only 0.5% of the time (0-11.5%[0-98.7%]), median (interquartile range [range]). Patients had a BIS < 40 for 99.6% (87.9-100%[0-100%]) of the duration of bronchoscopy. We identified one case of possible awareness. Few of our patients undergoing general anaesthesia for rigid bronchoscopy had BIS scores in the suggested range of between 40 and 60. BIS < 40 was more frequent than in previous studies of different surgical populations. There was no difference in the BIS values of patients anaesthetised with intermittent boluses or target controlled infusions of propofol.
硬质支气管镜检查与麻醉期间血流动力学紊乱及知晓发生率高相关。给予麻醉药物既能减弱对支气管镜检查的交感反应,又能预防知晓。使用脑电双频指数(Bispectral index,BIS)指导麻醉已显示可降低知晓率并缩短全身麻醉后的恢复时间。我们对50例接受硬质支气管镜检查常规麻醉患者的BIS值进行了一项前瞻性观察研究。发现支气管镜检查期间BIS值在40 - 60之间的时间仅占0.5%(0 - 11.5%[0 - 98.7%]),中位数(四分位间距[范围])。在支气管镜检查持续时间的99.6%(87.9 - 100%[0 - 100%])时间内患者的BIS < 40。我们发现了1例可能的知晓病例。接受硬质支气管镜检查全身麻醉的患者中,很少有人的BIS评分在建议的40至60范围内。BIS < 40比之前不同手术人群的研究更为常见。使用丙泊酚间断推注或靶控输注麻醉的患者BIS值无差异。