Ibraheim Osama, Alshaer Ahamad, Mazen Khalid, El-Dawlaty Abdelazeem, Turkistani Ahmed, Alkathery Khaled, Al-Zahrani Tariq, Al-Dohayan Abdullah, Bukhari Areej
Department of Anesthesia, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
Middle East J Anaesthesiol. 2008 Feb;19(4):819-30.
Early and uneventful postoperative recovery of morbidly obese patients remains a challenge for anesthesiologists. It could be valuable to titrate the administration of inhaled anesthetic, such as sevoflurane, in morbid obese patients, in order to shorten emergence using bispectral index (BIS) monitoring. It would be a great advantage if BIS permitted a more rapid recovery and less consumption in morbidly obese patients with a high cost inhaled agent. The aim of the study is to show whether the titration of sevoflurane based on the BIS monitoring would allow shortening of recovery time in morbidly obese patients and to evaluate whether BIS monitoring would contribute to reduce the amount of sevoflurane administered while providing an adequate anesthesia.
Thirty morbidly obese ASA I & II patients undergoing laparoscopic gastric banding (LAGB) procedures were studied. In the first group (15 patients), patients were anesthetized without the use of BIS (non BIS or control group), and sevoflurane being administered according to standard clinical practice (control group). In the second group (15 patients), sevoflurane was titrated to maintain a BIS value between 40 and 60 during surgery, and then 60-70 during 15 min prior to the end of surgery (BIS group). Recovery times were recorded. Time to extubation was also noted, as well as the time to achieve a modified Aldrete score of 9 were evaluated subsequently at 10-min intervals until 3 h after surgery by nurses who had no knowledge of the study. Sevoflurane consumption was calculated using the vaporizer weighing method.
Awakening and extubation times were significantly shorter in the BIS group (P < 0.05). In the BIS (vs. non BIS) group, there were no significant differences observed in the time to obtain an Aldrete score of 9. The sevoflurane consumption and cost in the BIS group were lower than in the non BIS group (P < 0.05).
Bispectral index monitoring during anesthesia for morbidly obese patients provides statistically significant reduction in recovery times. It also has the added advantage in decreasing sevoflurane consumption.
肥胖患者术后早期平稳恢复对麻醉医生来说仍是一项挑战。对于肥胖患者，滴定吸入麻醉药（如七氟醚）的给药剂量可能具有重要价值，以便使用脑电双频指数（BIS）监测来缩短苏醒时间。如果BIS能使肥胖患者使用高成本吸入剂时恢复更快且消耗量更少，那将是一大优势。本研究的目的是表明基于BIS监测滴定七氟醚是否能缩短肥胖患者的恢复时间，并评估BIS监测是否有助于在提供充分麻醉的同时减少七氟醚的给药量。
研究了30例接受腹腔镜胃束带术（LAGB）的肥胖ASA I & II级患者。第一组（15例患者），患者在麻醉过程中未使用BIS（非BIS组或对照组），七氟醚按照标准临床实践给药（对照组）。第二组（15例患者），在手术期间滴定七氟醚以维持BIS值在40至60之间，然后在手术结束前15分钟维持在60至70之间（BIS组）。记录恢复时间。还记录了拔管时间，并且由不了解该研究的护士随后每隔10分钟评估一次达到改良Aldrete评分为9的时间，直至术后3小时。使用蒸发器称重法计算七氟醚消耗量。
BIS组的苏醒和拔管时间明显更短（P < 0.05）。在BIS组（与非BIS组相比），达到Aldrete评分为9的时间没有显著差异。BIS组的七氟醚消耗量和成本低于非BIS组（P < 0.05）。
肥胖患者麻醉期间的脑电双频指数监测在统计学上显著缩短了恢复时间。它还具有减少七氟醚消耗量的额外优势。
