Faraoni D, Salengros J-C, Engelman E, Ickx B, Barvais L
CUB Erasmus Hospital, University Department of Anaesthesia-Reanimation, Route de Lennik, 808, Brussels, Belgium.
Br J Anaesth. 2009 Mar;102(3):336-9. doi: 10.1093/bja/aen403. Epub 2009 Feb 2.
Ketamine 0.15-1 mg kg(-1) decreases postoperative morphine consumption, but 0.5 mg kg(-1) is associated with an increase in the bispectral index (BIS) values that can lead to an overdose of hypnotic agents. The purpose of our investigation was to study the effect of ketamine 0.2 mg kg(-1) administered over a 5 min period on the BIS during stable target-controlled infusion (TCI) propofol-remifentanil general anaesthesia.
Thirty ASA I or II patients undergoing abdominal laparoscopic surgery were included in this double-blind, randomized study. Anaesthesia was induced and maintained with a TCI of propofol and remifentanil. After 5 min of steady-state anaesthesia (BIS at 40) without surgical stimulation, patients received either an infusion of ketamine 0.2 mg kg(-1) or normal saline. The test drug was infused over 5 min. Standard parameters and BIS values were recorded every minute until 15 min post-infusion.
The baseline mean (sd) value for the BIS was 37 (6.5) for the ketamine group and 39 (8.2) for the placebo group. The highest mean BIS value during the recording period was 41.5 (8.7) for the ketamine group and 40.1 (8.9) for the placebo group. BIS values were not statistically different between the groups (P=0.62); there was no significant change over time (P=0.65) with no group-time interaction (P=0.55).
Under stable propofol and remifentanil TCI anaesthesia, a slow bolus infusion of ketamine 0.2 mg kg(-1) administered over a 5 min period did not increase the BIS value over the next 15 min.
0.15 - 1毫克/千克的氯胺酮可减少术后吗啡用量，但0.5毫克/千克的氯胺酮会导致脑电双频指数（BIS）值升高，进而可能引起催眠药物过量。我们研究的目的是探讨在稳定的靶控输注（TCI）丙泊酚 - 瑞芬太尼全身麻醉期间，5分钟内静脉输注0.2毫克/千克氯胺酮对BIS的影响。
本双盲、随机研究纳入了30例接受腹部腹腔镜手术的美国麻醉医师协会（ASA）Ⅰ或Ⅱ级患者。采用丙泊酚和瑞芬太尼靶控输注诱导并维持麻醉。在无手术刺激的稳态麻醉（BIS为40）5分钟后，患者分别接受0.2毫克/千克氯胺酮输注或生理盐水输注。试验药物在5分钟内输注完毕。记录标准参数和BIS值，直至输注后15分钟，每分钟记录一次。
氯胺酮组BIS的基线平均（标准差）值为37（6.5），安慰剂组为39（8.2）。记录期间，氯胺酮组BIS的最高平均值得分为41.5（8.7），安慰剂组为40.1（8.9）。两组间BIS值无统计学差异（P = 0.62）；随时间无显著变化（P = 0.65），且无组间 - 时间交互作用（P = 0.55）。
在稳定的丙泊酚和瑞芬太尼TCI麻醉下，5分钟内缓慢推注0.2毫克/千克氯胺酮在接下来的15分钟内并未使BIS值升高。
