丙泊酚-瑞芬太尼麻醉下小儿患者脑电双频指数监测的变化

Variation of bispectral index monitoring in paediatric patients undergoing propofol-remifentanil anaesthesia.

作者信息

Liu J S, Zhang J M, Yue Y

机构信息

Capital Medical University, Beijing Tongren Hospital, Department of Anesthesiology, Beijing, China.

出版信息

Eur J Anaesthesiol. 2008 Oct;25(10):821-5. doi: 10.1017/S0265021508004559.

DOI:10.1017/S0265021508004559

PMID:18768092

Abstract

BACKGROUND AND OBJECTIVE

The technology of bispectral index monitoring is based on an algorithm developed from adults. This study was conducted to investigate the difference in bispectral index monitoring between paediatric and adult patients under intravenous anaesthesia.

METHODS

In all, 68 patients undergoing elective surgery were divided into three groups as follows: Group A (younger children, n = 20, 3 yr < or = yr < or = 5 yr), Group B (older children, n = 20, 6 yr < or = yr < or = 12 yr), Group C (adults, n = 28, 25 yr < or = yr < or = 50 yr). All patients were induced by plasma target-controlled infusion of propofol till loss of consciousness (loss of response to verbal commands and eyelash reflex). The plasma concentration (Cp(propofol)) and effect-site concentration (Ce(propofol)) of propofol and bispectral index values were compared at loss of consciousness and regaining of consciousness. During the operation, remifentanil was infused at a fixed rate of 0.25 microg kg (-1) min (-1), and the minute average bispectral index values of three groups were also compared at different stable concentrations of propofol (Ce(propofol) = Cp(propofol) = 2,3, 4 and 5 microg mL (-1), respectively).

RESULTS

At loss of consciousness and regaining of consciousness, the bispectral index values in Group A (loss of consciousness: 74.7 +/- 6.3, regaining of consciousness: 81.1 +/- 10.5) were significantly higher than those in Group C (loss of consciousness: 68.6 +/- 69.4, regaining of consciousness: 74.5 +/- 6.0) (P < 0.01). There was no statistical difference between Cp(propofol) in all groups at loss of consciousness and regaining of consciousness. The Ce(propofol) at loss of consciousness in Group A (3.57 +/- 0.60 microg mL (-1) and B (3.25 +/- 0.44 microg mL(-1)) were significantly higher than those in Group C (2.15 +/- 0.86 microg mL (-1)) (P < 0.01). At the same stable concentrations of propofol, the bispectral index values in Group A and B were significantly higher than those in Group C, and the bispectral index values in Group A were also significantly higher than those in Group B (P < 0.01). The Ce(propofol) when bispectral index < or = 40 in Group A, B, C were approximately at 6, 5 and 3 microg mL (-1), respectively.

CONCLUSIONS

At loss of consciousness and regaining of consciousness, the bispectral index values of younger children group are significantly higher than those of adults. At the same stable concentrations of propofol, the bispectral index values are significantly different between children and adults. This study suggests that there is deviation when the adult algorithm of bispectral index monitoring is applied in paediatric patients under intravenous anaesthesia.

摘要

背景与目的

脑电双频指数监测技术基于一种针对成年人开发的算法。本研究旨在探讨小儿与成年患者在静脉麻醉下脑电双频指数监测的差异。

方法

总共68例行择期手术的患者被分为以下三组：A组（年幼儿童，n = 20，3岁≤年龄≤5岁），B组（年长儿童，n = 20，6岁≤年龄≤12岁），C组（成年人，n = 28，25岁≤年龄≤50岁）。所有患者均通过血浆靶控输注丙泊酚诱导直至意识消失（对言语指令和睫毛反射无反应）。比较意识消失和意识恢复时丙泊酚的血浆浓度（Cp(丙泊酚)）、效应室浓度（Ce(丙泊酚)）以及脑电双频指数值。手术过程中，瑞芬太尼以0.25 μg·kg⁻¹·min⁻¹的固定速率输注，并且还比较了三组在丙泊酚不同稳定浓度（Ce(丙泊酚)=Cp(丙泊酚)=2、3、4和5 μg·mL⁻¹）时的分钟平均脑电双频指数值。

结果

意识消失和意识恢复时，A组的脑电双频指数值（意识消失：74.7±6.3，意识恢复：81.1±10.5）显著高于C组（意识消失：68.6±6.94，意识恢复：74.5±6.0）（P<0.01）。意识消失和意识恢复时所有组的Cp(丙泊酚)之间无统计学差异。A组（3.57±0.60 μg·mL⁻¹）和B组（3.25±0.44 μg·mL⁻¹）意识消失时的Ce(丙泊酚)显著高于C组（2.15±0.86 μg·mL⁻¹）（P<0.01）。在相同的丙泊酚稳定浓度下，A组和B组的脑电双频指数值显著高于C组，且A组的脑电双频指数值也显著高于B组（P<0.01）。A组、B组、C组脑电双频指数≤40时的Ce(丙泊酚)分别约为6、5和3 μg·mL⁻¹。