Dennhardt Nils, Beck Christiane, Boethig Dietmar, Heiderich Sebastian, Horke Alexander, Tiedge Sebastian, Boehne Martin, Sümpelmann Robert
1 Clinic for Anesthesiology and Intensive Care Medicine, Hanover Medical School, Hanover, Germany.
2 Clinic for Cardiac, Thoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
Perfusion. 2018 May;33(4):303-309. doi: 10.1177/0267659117746234. Epub 2017 Dec 4.
During cardiopulmonary bypass (CPB) in children, anesthesia maintained by sevoflurane administered via the oxygenator is increasingly common. Anesthetic uptake and requirement may be influenced by the non-physiological conditions during hypothermic CPB. Narcotrend-processed EEG monitoring may, therefore, be useful to guide the administration of sevoflurane during this phase.
The objective of this prospective, clinical, observational study was to assess the correlation between body temperature, Narcotrend Index (NI) and administered sevoflurane in children during CPB.
Forty-four children aged 0 to 10 years undergoing hypothermic cardiac surgery were studied. On bypass, anesthesia was maintained with sevoflurane administered via the oxygenator of the heart-lung machine. Nasopharyngeal temperature, NI and minimum alveolar concentration (MAC) of sevoflurane were recorded in intervals of 10 minutes. Expiratory gas was sampled from the oxygenator's sole expiratory port via a separate connecting line and the MAC was measured by the agent analyzer of the anesthesia machine.
Raw (r = 0.74) and corrected (r = 0.73) r-values show that narcosis depth (as indicated by NI) can primarily be explained by the interaction of MAC and temperature. The analysis of variance (without the interaction term) confirms the significant and independent association of both factors, MAC (p<0.004, 95%CI: 0.19 to 0.46) and temperature (p<0.0001, 95%CI: 0.68 to 0.78), with the NI. During hypothermia, sevoflurane had been reduced significantly (r = 0.41, p<0.0001, 95%CI: 0.33 to 0.48).
Perfusionists and anesthetists should be aware of the results of processed electroencephalograph (EEG) monitoring during CPB. Sevoflurane requirements differ inter-individually; they may decrease during cooling and increase during rewarming. Therefore, it seems reasonable to include the results of processed EEG monitoring when administering sevoflurane during CPB in children, but further studies are necessary to confirm this thesis.
在儿童体外循环（CPB）期间，通过氧合器给予七氟醚维持麻醉越来越普遍。低温CPB期间的非生理条件可能会影响麻醉药的摄取和需求。因此，Narcotrend处理的脑电图监测可能有助于在此阶段指导七氟醚的给药。
这项前瞻性、临床、观察性研究的目的是评估儿童CPB期间体温、Narcotrend指数（NI）与给予的七氟醚之间的相关性。
研究了44名年龄在0至10岁接受低温心脏手术的儿童。在体外循环期间，通过心肺机的氧合器给予七氟醚维持麻醉。每隔10分钟记录鼻咽温度、NI和七氟醚的最低肺泡浓度（MAC）。通过单独的连接线从氧合器的唯一呼气端口采集呼气气体，并由麻醉机的药剂分析仪测量MAC。
原始（r = 0.74）和校正（r = 0.73）的r值表明，麻醉深度（由NI表示）主要可以由MAC和温度的相互作用来解释。方差分析（不包括交互项）证实了MAC（p<0.004，95%CI：0.19至0.46）和温度（p<0.0001，95%CI：0.68至0.78）这两个因素与NI之间存在显著且独立的关联。在低温期间，七氟醚显著减少（r = 0.41，p<0.0001，95%CI：0.33至0.48）。
灌注师和麻醉师应了解CPB期间处理后的脑电图（EEG）监测结果。七氟醚的需求量个体差异较大；在降温期间可能会减少，在复温期间可能会增加。因此，在儿童CPB期间给予七氟醚时纳入处理后的EEG监测结果似乎是合理的，但需要进一步研究来证实这一论点。
