Department of Anesthesiology and Intensive Care Medicine, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
Anesthesiology. 2012 Feb;116(2):340-51. doi: 10.1097/ALN.0b013e3182410b5e.
We evaluated whether spectral entropy (SpE) can measure the depth of hypnosis and the hypnotic drug effect in children during total intravenous anesthesia.
Sixty healthy children, aged 3-16 yr, were studied. Anesthesia was induced with an increasing target controlled infusion of propofol, and maintained by a stable remifentanil infusion and variable concentrations of target controlled infusion propofol. Depth of hypnosis was assessed according to the University of Michigan Sedation Scale (UMSS). Estimated plasma (C(p)) and pseudo effect site (C(eff)) propofol concentrations reflected the hypnotic drug effect. Patients were stratified to three age groups. The correlations between SpE versus UMSS, C(p), and C(eff) were analyzed by Prediction Probability (P(k)). The pharmacodynamic relationship between SpE and C(p), and the differences of SpE values between the age groups at the corresponding UMSS levels, were studied.
Respective mean P(k) values for the youngest, middle, and oldest age groups were: 1) during induction: SpE versus UMSS 0.87, 0.87, and 0.93; SpE versus C(p) 0.92, 0.95, and 0.97; and SpE versus C(eff) 0.88, 0.94, and 0.95; 2) during maintenance: SpE versus C(eff) 0.86, 0.75, and 0.81. The pharmacodynamic analysis determined an association between SpE and C(p) that followed the E(max) model closely. There were significant differences in SpE values between age groups at corresponding UMSS sedation levels.
SpE measures the level of hypnosis and hypnotic drug effect in children during total intravenous anesthesia. There is an age dependency associated with SpE. Anesthesia should not be steered solely on the basis of SpE.
我们评估了在儿童全静脉麻醉期间，光谱熵（SpE）是否可以测量催眠深度和催眠药物效应。
研究了 60 名健康的 3-16 岁儿童。麻醉诱导采用异丙酚靶控输注递增，维持采用瑞芬太尼输注稳定和靶控输注异丙酚浓度可变。催眠深度根据密歇根大学镇静评分（UMSS）进行评估。估计的血浆（C（p））和假性效应部位（C（eff））异丙酚浓度反映了催眠药物的作用。将患者分为 3 个年龄组。通过预测概率（P（k））分析 SpE 与 UMSS、C（p）和 C（eff）的相关性。研究了 SpE 与 C（p）之间的药效学关系以及在相应的 UMSS 水平下，年龄组之间 SpE 值的差异。
年龄最小、中间和最大的年龄组的平均 P（k）值分别为：1）诱导期：SpE 与 UMSS 为 0.87、0.87 和 0.93；SpE 与 C（p）为 0.92、0.95 和 0.97；SpE 与 C（eff）为 0.88、0.94 和 0.95；2）维持期：SpE 与 C（eff）为 0.86、0.75 和 0.81。药效学分析确定了 SpE 与 C（p）之间的关联，该关联非常接近 E（max）模型。在相应的 UMSS 镇静水平下，年龄组之间的 SpE 值存在显著差异。
SpE 可测量儿童全静脉麻醉期间的催眠深度和催眠药物效应。SpE 与年龄有关。麻醉不应仅仅基于 SpE 进行指导。
