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年龄相关的七氟醚必需浓度，以实现联合硬膜外-全身麻醉的充分镇静。

Age-related requisite concentration of sevoflurane for adequate sedation with combined epidural-general anesthesia.

机构信息

Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

出版信息

Korean J Anesthesiol. 2013 Jun;64(6):489-93. doi: 10.4097/kjae.2013.64.6.489. Epub 2013 Jun 24.

DOI:10.4097/kjae.2013.64.6.489
PMID:23814647
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3695244/
Abstract

BACKGROUND

The requisite anesthetic concentration of sevoflurane required to obtain adequate sedation when sufficient analgesics are supplied has not been determined. The purpose of this study was to determine the requisite age-associated concentration of sevoflurane to obtain an adequate level of anesthesia during combined epidural-general anesthesia by bispectral index (BIS) monitoring.

METHODS

Twenty-seven elective abdominal surgery patients (American Society of Anesthesiologists physical status I-II) were enrolled. The patients were divided into two groups of more or less than 60 years of age. We investigated the concentration of sevoflurane required to obtain an adequate sedation level during combined epidural-general anesthesia, maintaining the BIS value between 40 and 60.

RESULTS

The requisite sevoflurane concentration required to keep the BIS value at 40-60 was not stable during surgery. In the younger group, the maximum concentration of sevoflurane needed during surgery was 1.95 ± 0.14 (95% confidence interval: 1.87-2.10) vol%, while it was 1.54 ± 0.44 (95% confidence interval: 1.27-1.80) vol% in the older group (P < 0.01).

CONCLUSIONS

The requisite concentration of sevoflurane required with combined epidural-general anesthesia was 2.5 vol% for the younger group and 2.0 vol% for the older group as determined by BIS monitoring. We believe that these percentages are sufficient to avoid awareness during surgery with adequate analgesia.

摘要

背景

在充分给予镇痛药物的情况下，获得充分镇静所需的七氟醚必需麻醉浓度尚未确定。本研究的目的是通过双谱指数（BIS）监测，确定在硬膜外-全身麻醉联合应用时获得足够麻醉深度所需的与年龄相关的七氟醚必需浓度。

方法

选择 27 例择期腹部手术患者（美国麻醉医师协会身体状况 I-II 级）。患者分为年龄大于或小于 60 岁两组。我们研究了在维持 BIS 值在 40-60 之间的情况下，获得充分镇静水平所需的七氟醚浓度。

结果

手术过程中，BIS 值在 40-60 之间所需的七氟醚浓度并不稳定。在年轻组中，手术过程中所需的七氟醚最大浓度为 1.95±0.14（95%置信区间：1.87-2.10）vol%，而在老年组中为 1.54±0.44（95%置信区间：1.27-1.80）vol%（P<0.01）。

结论

通过 BIS 监测，年轻组与老年组在硬膜外-全身麻醉联合应用时所需的七氟醚浓度分别为 2.5 vol%和 2.0 vol%。我们认为这些百分比足以在充分镇痛的情况下避免术中知晓。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ba0/3695244/6ea03b648c96/kjae-64-489-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ba0/3695244/6ea03b648c96/kjae-64-489-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ba0/3695244/6ea03b648c96/kjae-64-489-g001.jpg

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本文引用的文献

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Bispectral analysis during cardiopulmonary bypass: the effect of hypothermia on the hypnotic state.体外循环期间的双谱分析：低温对催眠状态的影响。
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Epidural lidocaine decreases sevoflurane requirement for adequate depth of anesthesia as measured by the Bispectral Index monitor.
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Development and clinical application of electroencephalographic bispectrum monitoring.脑电图双谱监测的发展与临床应用
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Electromyographic activity falsely elevates the bispectral index.肌电图活动会错误地提高脑电双频指数。
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