Department of Anesthesiology and Reanimation, Istanbul Training Hospital, Sağlık Bilimleri University, Istanbul, Turkey.
Department of Anesthesiology and Reanimation, Istanbul Training Hospital, Sağlık Bilimleri University, Istanbul, Turkey -
Minerva Anestesiol. 2018 Jan;84(1):33-39. doi: 10.23736/S0375-9393.17.11713-X. Epub 2017 Oct 4.
GABA (γ-aminobutyric acid) is the primary inhibitory neurotransmitter in the CNS and well-known target for general anesthetics. In addition, the dysregulation of GABA could be involved in the etiology of major depressive disorder (MDD). In this study, we aimed to determine whether MDD has any effect on anesthetic requirement measured by Bispectral Index (BIS).
This study was designed as a prospective, observational study, registered ANZCTR (ACTRN 12616001295437), with institutional review board approval and written informed consent. Inpatients who were planned to undergo laparoscopic cholecystectomy as an elective surgery, were enrolled in this study. Patients were divided into two groups, based on the results of the Beck Depression Inventory (BDI) which was assessed the 21-item self-administered scale measuring various symptoms of depression. If the BDI score was under 10, it was accepted as control group. Patients were consulted to the psychiatrist if the BDI score was 17 or more. Patients who were diagnosed as MDD by the psychiatrist, were classified as MDD group. Anesthesia was standardized, and delivered sevoflurane concentration was adjusted according to BIS value in both groups. Parameters of the study were heart rate, non-invasive arterial blood pressure, arterial oxygen saturation, BIS, end-tidal carbon dioxide, and end-tidal concentration of sevoflurane at 5-minute intervals during the operation.
End-tidal concentration of sevoflurane was found to be lower in MDD group during the maintenance phase of anesthesia. Mean end-tidal concentration of sevoflurane were significantly lower in MDD group (1.28±0.15) than control group (1.52±0.22) (P<0.0001). BIS values were lower at 5- and 10-minute intervals in MDD group in comparison with control group. BIS values were similar at other time intervals in both groups during surgery.
MDD might result in decreased end-tidal concentration of sevoflurane. Further study is required to identify the relationship between MDD and anesthetics.
γ-氨基丁酸（GABA）是中枢神经系统中主要的抑制性神经递质，也是全身麻醉剂的主要靶点。此外，GABA 的失调可能与重度抑郁症（MDD）的病因有关。在这项研究中，我们旨在确定 MDD 是否会对脑电双频指数（BIS）测量的麻醉需求产生影响。
这是一项前瞻性、观察性研究，在机构审查委员会的批准和书面知情同意下，进行了注册（ANZCTR：ACTRN12616001295437）。计划接受腹腔镜胆囊切除术的择期手术患者被纳入本研究。根据贝克抑郁量表（BDI）的结果将患者分为两组，BDI 是一种 21 项自我评估量表，用于测量各种抑郁症状。如果 BDI 评分低于 10，则被认为是对照组。如果 BDI 评分达到 17 或更高，则会咨询精神科医生。经精神科医生诊断为 MDD 的患者被归类为 MDD 组。两组患者均接受七氟醚麻醉，根据 BIS 值调整七氟醚浓度。研究的参数包括心率、无创动脉血压、动脉血氧饱和度、BIS、呼气末二氧化碳分压和呼气末七氟醚浓度，在手术过程中每隔 5 分钟测量一次。
在麻醉维持阶段，MDD 组的七氟醚呼气末浓度较低。与对照组（1.52±0.22）相比，MDD 组（1.28±0.15）的七氟醚呼气末浓度明显更低（P<0.0001）。与对照组相比，MDD 组在 5 分钟和 10 分钟时的 BIS 值较低。在手术过程中，两组在其他时间点的 BIS 值相似。
MDD 可能导致七氟醚呼气末浓度降低。需要进一步的研究来确定 MDD 与麻醉剂之间的关系。
