Department of Anesthesiology, Hôpital Foch, 40 rue Worth, 92151, Suresnes, France.
Can J Anaesth. 2013 Sep;60(9):881-7. doi: 10.1007/s12630-013-9986-7. Epub 2013 Jul 16.
Anesthesia for rigid bronchoscopic procedures is a demanding procedure. Automatic titration of propofol and remifentanil to maintain the bispectral index (BIS) within the recommended range (40-60) has been reported during routine surgical procedures. The aim of the present study was to evaluate its use during rigid bronchoscopy.
Patients were enrolled in a randomized study comparing manual target-controlled infusion of propofol and remifentanil (manual TCI group) with automatic titration guided by the BIS (dual-loop group). Categorical variables were compared by the Fisher's exact test, and continuous variables (median [interquartile range 25-75]) were compared by the Mann-Whitney test.
Thirty-four patients were included in the manual TCI group and 33 were included in the dual-loop group. Baseline characteristics were well balanced between the groups. Intervention by the anesthesiologist in charge to modify propofol and/or remifentanil targets in the dual-loop group was not necessary. Percentage of time spent in the BIS interval (40-60) was similar in the manual TCI and dual-loop groups (69% [48-79] vs 70% [58-80], respectively). Durations of induction and of maintenance and propofol and remifentanil doses were also similar between groups, except for the amount of propofol needed for induction (P = 0.002). Time to tracheal extubation was also similar. No case of intraoperational awareness was detected.
The present study could not establish the superiority of automatic system over manual adjustment for bronchoscopy. Further studies with a different design and a larger number of patients are required to establish the place of automatic delivery of anesthetic agents. This study was registered at ClinicalTrials.gov number, NCT00571181.
硬质支气管镜检查的麻醉是一项要求很高的操作。在常规手术过程中，已经有报道称，可以通过自动滴定异丙酚和瑞芬太尼来维持双频谱指数（BIS）在推荐范围内（40-60）。本研究的目的是评估其在硬质支气管镜检查中的应用。
将患者纳入一项随机研究，比较手动靶控输注异丙酚和瑞芬太尼（手动 TCI 组）与 BIS 引导的自动滴定（双环组）。分类变量通过 Fisher 精确检验进行比较，连续变量（中位数[25-75 四分位间距]）通过 Mann-Whitney 检验进行比较。
手动 TCI 组 34 例，双环组 33 例。两组患者的基线特征均衡。在双环组中，麻醉师不需要干预以修改异丙酚和/或瑞芬太尼的目标。在手动 TCI 和双环组中，BIS 间隔（40-60）的时间百分比相似（分别为 69%[48-79]和 70%[58-80]）。诱导和维持时间以及异丙酚和瑞芬太尼的剂量也相似，除了诱导所需的异丙酚量（P=0.002）。气管拔管时间也相似。未发现术中知晓病例。
本研究未能确定自动系统在支气管镜检查中优于手动调整。需要进一步设计不同、患者数量更多的研究来确定麻醉剂自动输送的地位。本研究在 ClinicalTrials.gov 注册号为 NCT00571181。
