Department of Anesthesiology and Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland.
Epilepsia. 2010 Aug;51(8):1580-6. doi: 10.1111/j.1528-1167.2009.02514.x. Epub 2010 Feb 3.
Appropriate treatment of generalized convulsive refractory status epilepticus (RSE) requires general anesthesia in the intensive care unit (ICU) with continuous electroencephalography (cEEG) monitoring. During out of office hours and weekends, cEEG monitoring is not always available. The Bispectral Index (BIS) monitor can be used to assess the hypnotic component of general anesthesia. We conducted a study to evaluate the feasibility of using the BIS monitoring to assess the burst suppression (BS) pattern during propofol anesthesia in RSE.
Ten adult patients with RSE admitted to the ICU were monitored simultaneously with cEEG and BIS monitoring. We compared the BIS and suppression ratio (SR) values with the EEG burst suppression pattern when the depth of anesthesia was titrated to the BS level monitoring by cEEG.
We found an excellent correlation between the cEEG burst rate per minute and the BIS (r² =-0.9; p< 0.001) and SR (r² = -0.88; p < 0.001). The sensitivity and specificity of BIS score of 30 to detect BS in electroencephalography were 99% and 98%, respectively. The BIS monitor was not able to recognize regional epileptic activity and epileptic bursts during the BS pattern.
The cEEG can be considered as the primary monitoring technique in the assessment of the depth of anesthesia in the treatment of RSE. If cEEG is not available, the BIS monitor can be used to guide the level of anesthesia, targeting BS in patients with RSE.
在重症监护病房（ICU）中进行全身麻醉并持续进行脑电图（cEEG）监测，是治疗全面性强直阵挛性难治性癫痫持续状态（RSE）的合理方法。但在非办公时间和周末，cEEG 监测并不总是可用。脑电双频指数（BIS）监测仪可用于评估全身麻醉的催眠成分。我们进行了一项研究，旨在评估使用 BIS 监测评估 RSE 中丙泊酚麻醉时爆发抑制（BS）模式的可行性。
对 10 例 ICU 中 RSE 患者同时进行 cEEG 和 BIS 监测。我们比较了在 cEEG 监测到 BS 水平时，调整麻醉深度时的 BIS 和抑制比（SR）值与脑电图的 BS 模式。
我们发现 cEEG 每分钟爆发率与 BIS（r² =-0.9；p<0.001）和 SR（r² = -0.88；p < 0.001）之间存在极好的相关性。BIS 评分为 30 分以检测脑电图 BS 的敏感性和特异性分别为 99%和 98%。BIS 监测仪无法识别 BS 模式下的局部癫痫活动和癫痫发作。
cEEG 可被视为评估 RSE 治疗中麻醉深度的主要监测技术。如果无法进行 cEEG，则可以使用 BIS 监测仪来指导麻醉水平，以针对 RSE 患者的 BS 为目标。
