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脑幕上肿瘤手术中使用脑电双频指数对麻醉药物用量、血流动力学及苏醒时间的影响

The Effect of BIS Usage on Anaesthetic Agent Consumption, Haemodynamics and Recovery Time in Supratentorial Mass Surgery.

作者信息

Karaca İclal, Akçıl Fatma Eren, Dilmen Özlem Korkmaz, Köksal Güniz Meyancı, Tunalı Yusuf

机构信息

Department of Anaesthesiology and Reanimation, Ege University Faculty of Medicine, İzmir, Turkey.

Department of Anaesthesiology and Reanimation, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.

出版信息

Turk J Anaesthesiol Reanim. 2014 Jun;42(3):117-22. doi: 10.5152/TJAR.2014.24892. Epub 2014 Mar 11.

Abstract

OBJECTIVE

In this study, we aimed to compare Bispectral Index (BIS) monitoring with the conventional anaesthesia approach based on haemodynamic changes in terms of anaesthetic agent consumption, haemodynamic recordings, recovery time and cost.

METHODS

This study was performed in 82 patients, aged 20 to 60 years, who were operated for supratentorial mass and were graded ASA I or II. Cases were randomly divided into two equal groups. In the standard control group haemodynamic parameters were used to determine depth of anaesthesia and in the BIS group, BIS monitoring was applied. In the BIS group the BIS values were kept between 40 and 60; in the control group haemodynamic changes within the range of +/-20% of initial values were controlled using appropriate anaesthetic practice. Haemodynamic parameters, awakening conditions and drug usage were recorded.

RESULTS

The difference between the two groups in terms of timing of eye opening and initial spontaneous breath was not statistically significant. The 'Aldrete' score at the 20(th) postoperative minute for the BIS group was significantly higher than the score calculated for the control group (p<0.05). Rocuronium consumption (mg kg(-1) hr(-1)) was significantly lower in the BIS group than the control group (p<0.05). Although a statistically significant difference (p<0.05) was found between the two groups in terms of initial heart rate and SpO2 values, there was no clinically significant difference in other haemodynamic parameters.

CONCLUSION

Although using BIS monitoring to evaluate depth of anaesthesia does not bring much benefit versus the use of haemodynamic parameters, it may be beneficial for selected surgeries such as awake craniotomy, for patients with a history of awareness and in haemodynamically unstable patients.

摘要

目的

在本研究中,我们旨在根据麻醉药物消耗、血流动力学记录、恢复时间和成本方面的血流动力学变化,比较脑电双频指数(BIS)监测与传统麻醉方法。

方法

本研究纳入了82例年龄在20至60岁之间、因幕上肿物接受手术且ASA分级为I或II级的患者。病例被随机分为两组,每组人数相等。在标准对照组中,使用血流动力学参数来确定麻醉深度,而在BIS组中,应用BIS监测。在BIS组中,BIS值保持在40至60之间;在对照组中,通过适当的麻醉操作控制血流动力学变化在初始值的+/-20%范围内。记录血流动力学参数、苏醒情况和药物使用情况。

结果

两组在睁眼时间和首次自主呼吸时间方面的差异无统计学意义。BIS组术后第20分钟的“Aldrete”评分显著高于对照组计算的评分(p<0.05)。BIS组罗库溴铵的消耗量(mg·kg⁻¹·hr⁻¹)显著低于对照组(p<0.05)。虽然两组在初始心率和SpO₂值方面存在统计学显著差异(p<0.05),但在其他血流动力学参数方面无临床显著差异。

结论

尽管使用BIS监测评估麻醉深度与使用血流动力学参数相比并没有带来太多益处,但对于某些特定手术,如清醒开颅手术、有术中知晓史的患者以及血流动力学不稳定的患者,可能是有益的。

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