Büttner N, Schultz B, Grouven U, Schultz A
Arbeitsgruppe Informatik/Biometrie der Anästhesie, Klinikum Region Hannover Oststadt-Heidehaus, Medizinische Hochschule Hannover, Deutschland.
Anaesthesist. 2010 Feb;59(2):126-34. doi: 10.1007/s00101-009-1666-1.
The aim of this study was to examine to what extent the use of electroencephalography (EEG) monitoring leads to an adaptation of the target-controlled infusion (TCI) concentration of propofol during propofol anaesthesia with different doses of remifentanil.
With ethics committee approval 60 patients (27-69 years old) with American Society of Anesthesiologists classification (ASA) I-III received anaesthestics with propofol (TCI, Diprifusor, AstraZeneca, Wedel, Deutschland) and 0.2, 0.4, or 0.6 microg/kg body weight remifentanil, respectively (groups 1-3). Anaesthesia was maintained at a level of deep hypnosis (EEG stages D(2)/E(0), EEG monitor: Narcotrend, version 2.0/5.0, manufacturer: MT MonitorTechnik, Bad Bramstedt, Germany).
During the steady state the propofol concentration in groups 1-3 was 3.02+/-0.86, 1.93+/-0.53 and 1.60+/-0.55 microg/ml, respectively (p<0.001). Women had a higher propofol consumption than men (p<0.05). Dreams during anaesthesia were more often reported by women than by men (p<0.05). The need for postoperative analgesia decreased with an increasing intraoperative remifentanil dose (p<0.05).
The study demonstrates that remifentanil has both analgetic and hypnotic effects. With increasing remifentanil dose the propofol requirement decreased and in this context EEG monitoring is useful to adapt the target concentrations of propofol to the patients' age and gender.
本研究旨在探讨在不同剂量瑞芬太尼的丙泊酚麻醉过程中，脑电图（EEG）监测在多大程度上会导致丙泊酚靶控输注（TCI）浓度的调整。
经伦理委员会批准，60例年龄在27 - 69岁、美国麻醉医师协会（ASA）分级为I - III级的患者分别接受丙泊酚（TCI，得普利麻，阿斯利康公司，德国韦德尔）和0.2、0.4或0.6微克/千克体重瑞芬太尼的麻醉（1 - 3组）。麻醉维持在深度催眠水平（EEG分期D(2)/E(0)，EEG监测仪：脑电意识深度监测系统，版本2.0/5.0，制造商：德国巴特布拉姆斯泰特的MT MonitorTechnik公司）。
在稳态时，1 - 3组的丙泊酚浓度分别为3.02±0.86、1.93±0.53和1.60±0.55微克/毫升（p<0.001）。女性的丙泊酚消耗量高于男性（p<0.05）。女性在麻醉期间报告做梦的情况比男性更频繁（p<0.05）。随着术中瑞芬太尼剂量的增加，术后镇痛的需求减少（p<0.05）。
该研究表明瑞芬太尼具有镇痛和催眠作用。随着瑞芬太尼剂量的增加，丙泊酚需求量减少，在此背景下，EEG监测有助于根据患者的年龄和性别调整丙泊酚的靶浓度。
