Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
Anesthesiology. 2010 Mar;112(3):645-51. doi: 10.1097/ALN.0b013e3181cf4111.
Neurosurgical procedures that require a frontal approach could be an impediment for a successful Bispectral Index (BIS) frontal sensor placement. The aim of this study was to explore the utility of using the new BIS-Vista monitor (Aspect Medical Systems, Newton, MA) for occipital sensor placement in the patients undergoing brain neurosurgical procedures during propofol-remifentanil anesthesia.
Two BIS Quatro sensors (Aspect Medical Systems, Newton, MA) mounted on the occipital and frontal regions were connected to two BIS-Vista monitors at three anesthesia states: before induction, during anesthesia maintenance, and recovery.
There were significant differences before induction (P = 0.0002) and at anesthesia maintenance (P = 0.0014) between mean +/- SD occipital (83.4 +/- 4.8, 66.7 +/- 7.2) and frontal (93.1 +/- 3.4, 56.9 +/- 9.1) BIS-Vista values. During anesthesia recovery, there was no difference (P = 0.7421) between occipital (54.6 +/- 9.3) and frontal (53.1 +/- 7.3) BIS-Vista values. Bland and Altman analysis revealed a BIS-Vista negative-bias (limits of agreement) of -9.7 (+1.1, -20.5) before anesthesia induction, +9.8 positive-bias (+22.8, -1.7) during anesthesia maintenance, and -0.9 bias (+10.9, -12.8) during anesthesia recovery.
We demonstrated that not only the regional limits of agreement are too wide to allow data of the two montages to be used interchangeably but also the variation is a function of anesthetic depth. However, keeping in mind a relatively consistent BIS-Vista -10 bias before induction and +10 bias during anesthesia maintenance with limits of agreement of approximately +/-11 BIS units, approximately double the clinically acceptable less than 10 BIS units level of agreement, BIS-Vista off-label occipital montage might be helpful in following a trend of propofol-remifentanil anesthesia in individual cases where frontal access is particularly difficult.
需要前额入路的神经外科手术可能会妨碍 bispectral index (BIS) 额部传感器的成功放置。本研究旨在探讨在接受异丙酚-瑞芬太尼麻醉的脑神经外科手术患者中，使用新型 BIS-Vista 监测仪（Aspect Medical Systems，马萨诸塞州牛顿）进行枕部传感器放置的效果。
将两个 BIS Quatro 传感器（Aspect Medical Systems，马萨诸塞州牛顿）安装在枕部和额部，在三个麻醉状态下连接到两个 BIS-Vista 监测仪：诱导前、麻醉维持期间和恢复期间。
诱导前（P = 0.0002）和麻醉维持期间（P = 0.0014），枕部（83.4 ± 4.8，66.7 ± 7.2）和额部（93.1 ± 3.4，56.9 ± 9.1）BIS-Vista 值的平均值 ± SD 之间存在显著差异。麻醉恢复期间，枕部（54.6 ± 9.3）和额部（53.1 ± 7.3）BIS-Vista 值之间无差异（P = 0.7421）。Bland-Altman 分析显示，诱导前 BIS-Vista 存在负偏差（一致性界限）-9.7（+1.1，-20.5），麻醉维持期间存在正偏差+9.8（+22.8，-1.7），麻醉恢复期间存在负偏差-0.9（+10.9，-12.8）。
我们证明，不仅两个监测仪的区域一致性界限太宽，无法互换使用，而且变异是麻醉深度的函数。然而，考虑到诱导前的相对一致的 BIS-Vista -10 偏差和麻醉维持期间的+10 偏差，一致性界限约为 +/-11 BIS 单位，大约是临床可接受的小于 10 BIS 单位水平的两倍，BIS-Vista 枕部监测仪的标签外放置在特别难以获得额部通路的情况下，可能有助于跟踪异丙酚-瑞芬太尼麻醉的趋势。
