Department of Anaesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany.
Anaesthesia. 2011 Dec;66(12):1112-20. doi: 10.1111/j.1365-2044.2011.06875.x. Epub 2011 Sep 23.
We developed a closed-loop system to control the depth of anaesthesia and neuromuscular blockade using the bispectral index and the electromyogram simultaneously and evaluated the clinical performance of this combined system for general anaesthesia. Twenty-two adult patients were included in this study. Anaesthesia was induced by a continuous infusion of remifentanil at 0.4 μg.kg(-1) .min(-1) (induction dose) and then 0.25 μg.kg(-1) .min(-1) (maintenance dose) and propofol at 2 mg.kg(-1) 3 min later. The combined automatic control was started 2 min after tracheal intubation. The depth of anaesthesia was recorded using bispectral index monitoring using a target value of 40. The target value of neuromuscular blockade, using mivacurium, was a T1/T1(0) twitch height of 10%. The precision of the system was calculated using internationally defined performance parameters. Twenty patients were included in the data analysis. The mean (SD) duration of simultaneous control was 129 (69) min. No human intervention was necessary during the computer-controlled administration of propofol and mivacurium. All patients assessed the quality of anaesthesia as 'good' to 'very good'; there were no episodes of awareness. The mean (SD) median performance error, median absolute performance error and wobble for the control of depth of anaesthesia and for neuromuscular blockade were -0.31 (1.78), 6.76 (3.45), 6.32 (2.93) and -0.38 (1.68), 3.75 (4.83), 3.63 (4.69), respectively. The simultaneous closed-loop system using propofol and mivacurium was able to maintain the target values with a high level of precision in a clinical setting.
我们开发了一个闭环系统，同时使用双频谱指数和肌电图来控制麻醉深度和神经肌肉阻滞，并评估了这种用于全身麻醉的联合系统的临床性能。这项研究纳入了 22 名成年患者。麻醉诱导采用持续输注瑞芬太尼 0.4μg·kg-1·min-1（诱导剂量）和随后的 0.25μg·kg-1·min-1（维持剂量），3 分钟后给予丙泊酚 2mg·kg-1。气管插管后 2 分钟开始联合自动控制。使用双频谱指数监测，将麻醉深度记录为目标值 40。使用维库溴铵，神经肌肉阻滞的目标值为 T1/T1（0）的颤搐高度为 10%。使用国际定义的性能参数计算系统的精度。20 名患者纳入数据分析。同时控制的平均（SD）持续时间为 129（69）分钟。在丙泊酚和维库溴铵的计算机控制给药期间，无需人为干预。所有患者均评估麻醉质量为“好”至“非常好”；无知晓事件发生。麻醉深度和神经肌肉阻滞的控制的中位性能误差、中位绝对性能误差和摆动的平均值（SD）分别为-0.31（1.78）、6.76（3.45）、6.32（2.93）和-0.38（1.68）、3.75（4.83）、3.63（4.69）。在临床环境中，使用丙泊酚和维库溴铵的同时闭环系统能够以高精度维持目标值。
