Lim Byung Gun, Lee Il Ok, Kim Young Sung, Won Young Ju, Kim Heezoo, Kong Myoung Hoon
Department of Anaesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Medicine (Baltimore). 2017 Jan;96(2):e5871. doi: 10.1097/MD.0000000000005871.
This study was designed to determine whether a deep hypnotic state with a bispectral index (BIS) value less than 40 could alleviate withdrawal movement (WM) upon rocuronium injection during anesthesia induction in children.
Finally, 135 healthy children (3-12 years) scheduled for minor elective surgery were studied. Without premedication, anesthesia was induced with thiopental sodium 5 mg/kg. Patients were randomized into 2 groups (control vs experimental) and then by virtue of rocuronium injection time, patients in the experimental group were allocated into 2 groups, as follows: in the control group (group C; n = 45), rocuronium 0.6 mg/kg was administered at the loss of eyelash reflex; in the 1st experimental group, rocuronium 0.6 mg/kg was administered when BIS fell to less than 40 (group T; n = 45); however, if BIS did not fall below 40 after thiopental sodium administration, manual ventilation was provided with oxygen 6 L/minute using sevoflurane 8% and then rocuronium was administered when BIS fell below 40 (the 2nd experimental group, group S; n = 45). Rocuronium-induced WM was evaluated using a 4-point scale (no movement; movement/withdrawal involving the arm only; generalized response, with movement/withdrawal of more than 1 extremity, but no requirement for restraint of the body; and generalized response which required restraint of the body and caused coughing or breath-holding).
No significant differences were found among the groups for patient characteristics including age, sex, height, and location of venous cannula. However, body weight, height, and body mass index in group S were all smaller than those in group T. The incidence of WM caused by rocuronium was 100% in group C, 95.6% in group T, and 80% in group S, and was significantly lower in group S than in group C. The grade of WM was 3.7 ± 0.6 in group C, 3.2 ± 0.9 in group T, and 2.6 ± 1.0 in group S. It was significantly lower in group T than in group C and significantly lower in group S than in groups C and T.
The confirmation of a deep hypnotic state with BIS values lower than 40 using BIS monitoring can reduce the grade of rocuronium-induced WMs during anesthesia induction using thiopental sodium or sevoflurane in children.
本研究旨在确定在儿童麻醉诱导期间，脑电双频指数（BIS）值低于40的深度催眠状态是否能减轻注射罗库溴铵后的退缩运动（WM）。
最终，对135例计划进行择期小手术的健康儿童（3至12岁）进行了研究。未给予术前用药，采用硫喷妥钠5mg/kg诱导麻醉。将患者随机分为2组（对照组与实验组），然后根据罗库溴铵注射时间，将实验组患者分为2组，具体如下：对照组（C组；n = 45），在睫毛反射消失时给予罗库溴铵0.6mg/kg；第一实验组，当BIS降至低于40时给予罗库溴铵0.6mg/kg（T组；n = 45）；然而，如果给予硫喷妥钠后BIS未降至40以下，则使用8%七氟醚以6L/分钟的氧气流量进行手动通气，然后当BIS降至40以下时给予罗库溴铵（第二实验组，S组；n = 45）。使用4分制量表评估罗库溴铵诱导的WM（无运动；仅涉及手臂的运动/退缩；全身反应，有一个以上肢体的运动/退缩，但无需约束身体；全身反应，需要约束身体并导致咳嗽或屏气）。
在患者特征（包括年龄、性别、身高和静脉置管位置）方面，各组之间未发现显著差异。然而，S组的体重、身高和体重指数均低于T组。罗库溴铵引起的WM发生率在C组为100%，T组为95.6%，S组为80%，S组显著低于C组。WM分级在C组为3.7±0.6，T组为3.2±0.9，S组为2.6±1.0。T组显著低于C组，S组显著低于C组和T组。
使用BIS监测确认BIS值低于40的深度催眠状态，可降低儿童在使用硫喷妥钠或七氟醚进行麻醉诱导期间罗库溴铵诱导的WM分级。
