Gnaneswaran Hari Haran, Jain Gaurav, Agarwal Ankit, Chug Ashi, Singla Deepak
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, 249203, Uttarakhand, India.
Department of Dentistry and Craniomaxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, 249203, Uttarakhand, India.
J Oral Biol Craniofac Res. 2020 Jul-Sep;10(3):299-303. doi: 10.1016/j.jobcr.2020.06.004. Epub 2020 Jun 22.
Bispectral index (BIS) has been in practice as an objective tool to measure the depth of conscious sedation. The data on adequate levels for awake fiberoptic nasotracheal intubation (AFNI) is however scarce. We aimed to obtain an optimal level of BIS required for achieving the adequate conscious sedation in AFNI procedure.
In a prospective, observational, outcome assessor blinded cohort trial, 94 consecutive patients with anticipated difficult intubation and undergoing AFNI for any elective surgery were enrolled. The topical anesthesia and sedation were induced with lidocaine and dexmedetomidine, while keeping the patient awake. The sedation levels were targeted to BIS ≤90 and Ramsay sedation score (RSS)≥2 to attempt intubation. Propofol bolus were administered if patients get agitated. The primary outcome was "Stable BIS", the lowest BIS at which intubation could be feasibly performed. A receiver operator characteristic curve, Youden index, and correlation analysis were used.
The optimal criterion for BIS was obtained as ≤86 (AUC: 0.80, sensitivity 88.30%, specificity 61.45%, Youden index 49.74). The stable BIS ranged from 80 to 88, while RSS varied from 1 to 3. The BIS and RSS correlated significantly (r: 0.83). The stable BIS was independent of any baseline characteristics. Six patients had transient untoward events, none requiring any intervention.
BIS serves as an effective objective tool for titrating the depth of conscious sedation. We advocate a BIS range of 80-86 for feasibly performing the AFNI procedure.
脑电双频指数（BIS）已被用作测量清醒镇静深度的客观工具。然而，关于清醒纤维支气管镜引导下鼻插管（AFNI）合适水平的数据却很少。我们旨在获得AFNI手术中实现充分清醒镇静所需的最佳BIS水平。
在一项前瞻性、观察性、结果评估者盲法队列试验中，连续纳入94例预计插管困难且因任何择期手术接受AFNI的患者。采用利多卡因和右美托咪定进行表面麻醉和镇静，同时保持患者清醒。镇静水平目标为BIS≤90且拉姆齐镇静评分（RSS）≥2以尝试插管。如果患者躁动，则给予丙泊酚推注。主要结局是“稳定BIS”，即能够顺利进行插管的最低BIS。使用受试者工作特征曲线、约登指数和相关性分析。
获得的BIS最佳标准为≤86（曲线下面积：0.80，灵敏度88.30%，特异度61.45%，约登指数49.74）。稳定BIS范围为80至88，而RSS范围为1至3。BIS与RSS显著相关（r：0.83）。稳定BIS与任何基线特征无关。6例患者出现短暂不良事件，均无需任何干预。
BIS是滴定清醒镇静深度的有效客观工具。我们提倡在80 - 86的BIS范围内以顺利进行AFNI手术。
