Davidson Andrew J
Department of Anaesthesia & Pain Management, Royal Children's Hospital, Melbourne, Australia.
Curr Opin Anaesthesiol. 2007 Jun;20(3):236-43. doi: 10.1097/ACO.0b013e3280c60c66.
There are several commercially available electroencephalogram-derived devices for monitoring anaesthesia depth. This article reviews all published studies describing their use in children; first assessing studies of performance in measuring anaesthesia depth in observational, physiological studies and then describing relevant outcome studies. There is also a brief discussion of why they might be useful, what physiological problems may arise and what the reader should be wary of in the methodology of these studies. The subject is approached from a clinical perspective.
There are several physiological studies suggesting that for older children the bispectral index, entropy, Narcotrend index, cerebral state index and A-line ARX index all change with induction of anaesthesia, and have reasonable correlations with doses of anaesthetic agent. There is consistent evidence that the performances are substantially poorer in infants. Some of these devices have been demonstrated to reduce anaesthesia drug consumption and hasten recovery in older children.
The bispectral index is the most widely studied, but at this stage there is no evidence to suggest any one device is substantially superior to any other. There may be a role emerging for their use in older children, but their use in infants cannot be supported.
有几种市售的基于脑电图的设备可用于监测麻醉深度。本文回顾了所有已发表的描述其在儿童中应用的研究；首先评估在观察性、生理学研究中测量麻醉深度的性能研究，然后描述相关的结局研究。还简要讨论了它们可能有用的原因、可能出现的生理问题以及读者在这些研究方法中应警惕的事项。本文从临床角度探讨该主题。
多项生理学研究表明，对于大龄儿童，脑电双频指数、熵指数、脑状态指数和A线ARX指数在麻醉诱导时均会发生变化，且与麻醉剂剂量有合理的相关性。有一致证据表明，这些设备在婴儿中的性能要差得多。其中一些设备已被证明可减少大龄儿童的麻醉药物消耗并加速恢复。
脑电双频指数是研究最广泛的，但现阶段没有证据表明任何一种设备明显优于其他设备。它们在大龄儿童中的应用可能会逐渐发挥作用，但不支持在婴儿中使用。
