Department of Anesthesiology, Yantai Yuhuangding Hospital, Medical College, Qingdao University, Yantai, China.
J Cardiothorac Vasc Anesth. 2012 Oct;26(5):818-21. doi: 10.1053/j.jvca.2012.01.028. Epub 2012 Apr 12.
The measurement of the depth of anesthesia is of clinical interest for patients undergoing off-pump coronary artery bypass graft (OPCAB) surgery in order to avoid intraoperative awareness and cardiac depression. Entropy recently was introduced as a monitor of anesthetic depth. This study was conducted to investigate the feasibility of entropy monitoring during the conduct of OPCAB surgery and to find out whether it reduced the anesthetic dosage for patients undergoing OPCAB surgery.
A prospective, randomized, single-blind, controlled study.
A teaching hospital.
Seventy patients scheduled for OPCAB surgery were randomized to receive propofol-sufentanil anesthesia either with the entropy values visible (the entropy group, n = 35) or without the entropy values visible (the control group, n = 35).
In the entropy group, propofol and sufentanil infusion rates were titrated to maintain a state entropy (SE) value of 45 to 55 and a response entropy (RE)-SE difference below 10 U. In the control group, patients were anesthetized to keep the heart rate and blood pressure within 25% of the baseline values.
The course of surgery, the consumption of anesthetics, and intraoperative recall were recorded. Plasma levels of adrenocorticotropic hormone (ACTH) and cortisol were measured. The average SE during anesthesia was 50 ± 5 in the entropy group; the entropy values were lower in the control group (p < 0.05). Compared with the control group, propofol and sufentanil consumption were significantly less in the entropy group, which shortened the time to tracheal extubation (p < 0.05). Significantly, patients in the control group needed more phenylephrine to maintain arterial pressure than patients in the entropy group (p < 0.05). ACTH and cortisol release were prevented completely, and there was no intraoperative recall reported in the 2 groups.
Entropy monitoring reduced propofol and sufentanil dosage for patients undergoing OPCAB surgery.
在非体外循环冠状动脉旁路移植术（OPCAB）中，为了避免术中意识和心脏抑制，麻醉深度的测量具有临床意义。熵最近被引入作为麻醉深度的监测指标。本研究旨在探讨熵监测在 OPCAB 手术中的可行性，并确定它是否能减少 OPCAB 手术患者的麻醉剂量。
前瞻性、随机、单盲、对照研究。
教学医院。
70 例拟行 OPCAB 手术的患者随机分为两组，接受异丙酚-舒芬太尼麻醉，一组可见熵值（熵组，n=35），另一组不可见熵值（对照组，n=35）。
在熵组中，通过调整异丙酚和舒芬太尼的输注速度，将状态熵（SE）值维持在 45 至 55 之间，反应熵（RE）-SE 差值低于 10 U。在对照组中，患者被麻醉以保持心率和血压在基线值的 25%以内。
记录手术过程、麻醉药物的消耗和术中回忆情况。测量血浆促肾上腺皮质激素（ACTH）和皮质醇水平。麻醉期间平均 SE 为 50±5，熵组较低（p<0.05）。与对照组相比，熵组异丙酚和舒芬太尼的用量明显减少，气管拔管时间缩短（p<0.05）。值得注意的是，与熵组相比，对照组患者需要更多的去氧肾上腺素来维持动脉压（p<0.05）。两组患者均完全抑制了 ACTH 和皮质醇的释放，且均无术中回忆。
熵监测减少了 OPCAB 手术患者的异丙酚和舒芬太尼用量。
