Fernández-Candil Juan L, Terradas Susana Pacreu, Barriuso Esther Vilà, García Luis Moltó, Cogollo Marina García, Gallego Lluís Gallart
Anesthesiology Department, Parc Salut Mar, Institut Hospital del Mar D'Investigacions Mèdiques (IMIM), Barcelona, Spain.
Vascular Surgery Department, Hospital de Getafe, Madrid, Spain.
J Clin Monit Comput. 2021 Aug;35(4):723-729. doi: 10.1007/s10877-020-00528-5. Epub 2020 May 14.
During anesthesia induction with propofol the level of arousal progressively decreases until reaching loss of consciousness (LOC). In addition, there is a shift of alpha activity from parieto-occipital to frontal zones, defined as anteriorization. Whilst monitoring LOC and anteriorization would be useful to improve propofol dosage and patient safety, the current devices for anesthetic depth monitoring are unable to detect these events. The aim of this study was to observe LOC and anteriorization during anesthesia induction with propofol by applying electrodes placed in the frontal and parietal areas. Bispectral index (BIS) and quantium consciousness index (qCON) monitors were simultaneously employed. BIS™ and qCON sensors were placed in the frontal and parieto-occipital regions of 10 alopecic patients who underwent anesthesia with propofol, alfentanil, and remifentanil. The initial biophase target of propofol was 2.5 mcg/mL which was gradually increased until reaching LOC. Wilcoxon signed-rank test was used to study differences in alpha power and qCON/BIS indices along the study; and Pk value to evaluate predictive capability of anteriorization of BIS, qCON, and alpha waves. Parietal BIS and qCON values became significantly higher than frontal values 15 min after loss of eye reflex. Anteriorization was observed with both monitors. Pk values for BIS and qCON were strongly predictive of frontal alpha absolute power. During anesthesia induction with propofol it is possible to identify anteriorization with BIS and qCON in the frontal and parieto-occipital regions. Both indices showed different patterns which need to be further studied.
在使用丙泊酚进行麻醉诱导期间，觉醒水平逐渐降低直至意识丧失（LOC）。此外，α波活动从顶枕区转移至额叶区，即所谓的前移。虽然监测LOC和前移对于优化丙泊酚剂量及提高患者安全性会有帮助，但目前的麻醉深度监测设备无法检测到这些事件。本研究的目的是通过在额叶和顶叶区域放置电极，观察丙泊酚麻醉诱导期间的LOC和前移情况。同时使用了脑电双频指数（BIS）和量子意识指数（qCON）监测仪。将BIS™和qCON传感器放置在10例接受丙泊酚、阿芬太尼和瑞芬太尼麻醉的脱发患者的额叶和顶枕区。丙泊酚的初始生物相目标浓度为2.5微克/毫升，逐渐增加直至达到LOC。采用Wilcoxon符号秩检验研究整个研究过程中α波功率以及qCON/BIS指数的差异；并使用Pk值评估BIS、qCON和α波前移的预测能力。眼反射消失15分钟后，顶叶的BIS和qCON值显著高于额叶值。两种监测仪均观察到了前移现象。BIS和qCON的Pk值对额叶α波绝对功率具有较强的预测性。在丙泊酚麻醉诱导期间，可以通过BIS和qCON识别额叶和顶枕区的前移情况。两种指数均呈现出不同的模式，有待进一步研究。
