逐拍心血管指数，CARDEAN：一项前瞻性随机评估其在减少结肠镜检查期间运动的效用。

A beat-by-beat cardiovascular index, CARDEAN: a prospective randomized assessment of its utility for the reduction of movement during colonoscopy.

机构信息

Department of Anesthesiology/Critical Care Medicine, Hôpital d'Instruction des Armées Desgenettes, Lyon-Villeurbanne, France.

出版信息

Anesth Analg. 2010 Mar 1;110(3):765-72. doi: 10.1213/ANE.0b013e3181cc9ebe.

DOI:10.1213/ANE.0b013e3181cc9ebe

PMID:20185655

Abstract

BACKGROUND

We sought to determine whether online use of a beat-by-beat cardiovascular index, CARDEAN (Alpha-2, Lyon, France), modifies the incidence of patient movement during colonoscopy under anesthesia.

METHODS

Monitoring included an electrocardiogram, oscillometric and noninvasive beat-by-beat arterial blood pressure, O2 saturation, bispectral index (BIS), and CARDEAN. CARDEAN consists of beat-by-beat Finapres (Ohmeda, Madison, WI) combined with an algorithm that detects hypertension followed by tachycardia and produces an index scaled 0 to 100. The anesthesiologist was denied access to Finapres and CARDEAN. Propofol was adjusted to keep 40<BIS<60. Alfentanil 3.5 microg x kg(-1) was administered according to conventional signs (tachycardia, hypertension, and movement), unless the patient had signs of brady/apnea or Spo(2) <95%. One hundred fifty-nine patients presenting for colonoscopy under propofol anesthesia were prospectively randomized to (i) control: no other intervention, or (ii) CARDEAN: in addition to conventional signs, an observer instructed the anesthesiologist to administer alfentanil when CARDEAN was >60. The primary outcome was the number of observed movements.

RESULTS

Data were analyzed in 146 patients (control: 75; CARDEAN: 71). The doses of propofol and alfentanil were similar in both groups. When BIS was <60, movements were less frequent in the CARDEAN group (3.3 movements/100 min [2.3-4.8]) than in the control group (6.7 [5.3-8.5]) (odds ratio: 0.5 [0.32; 0.76], P = 0.001). During the first 10 minutes of the procedure, the incidence of movements was 38% and 59% in the CARDEAN and control groups, respectively (P = 0.04).

CONCLUSION

With BIS <60, CARDEAN-guided opioid administration is associated with a reduction of 51% of clinically unpredictable movements in unparalyzed patients undergoing colonoscopy. More studies are required to refine the role of CARDEAN in surgical settings.

摘要

背景

我们旨在确定在麻醉下进行结肠镜检查期间，是否可以通过在线使用逐拍心血管指数（CARDEAN，法国里昂的 Alpha-2）来减少患者的运动发生率。

方法

监测包括心电图、振荡式和无创性逐拍动脉血压、O2 饱和度、双谱指数（BIS）和 CARDEAN。CARDEAN 由逐拍 Finapres（Ohmeda，威斯康星州麦迪逊）组成，结合一种算法，可检测高血压后出现的心动过速，并产生 0 到 100 的指数。麻醉师无法访问 Finapres 和 CARDEAN。根据 40<BIS<60 调整丙泊酚。根据常规体征（心动过速、高血压和运动）给予阿芬太尼 3.5 μg x kg(-1)，除非患者出现心动过缓/呼吸暂停或 Spo(2) <95%。159 名接受丙泊酚麻醉下结肠镜检查的患者前瞻性随机分为（i）对照组：无其他干预，或（ii）CARDEAN 组：除常规体征外，当 CARDEAN >60 时，观察者指示麻醉师给予阿芬太尼。主要结局是观察到的运动次数。

结果

146 名患者（对照组 75 名；CARDEAN 组 71 名）的数据进行了分析。两组丙泊酚和阿芬太尼的剂量相似。当 BIS <60 时，CARDEAN 组的运动频率较低（每 100 分钟 3.3 次[2.3-4.8]），而对照组为 6.7 次[5.3-8.5]（比值比：0.5[0.32;0.76]，P = 0.001）。在手术的前 10 分钟，CARDEAN 组和对照组的运动发生率分别为 38%和 59%（P = 0.04）。