Anaesthesia, Hôpital D'Instruction Des Armées Desgenettes, Lyon, France.
CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Biostatistique et Santé, Lyon, France.
J Clin Monit Comput. 2021 Dec;35(6):1311-1324. doi: 10.1007/s10877-020-00597-6. Epub 2020 Oct 6.
To determine whether a beat-by-beat cardiovascular index (CARDEAN: cardiovascular depth of analgesia, Alpha-2 Ltd, Lyon, France) reduces the incidence of tachycardia in ASA I-III patients undergoing orthopaedic surgery. A total of 76 patients were prospectively randomized into (1) a control group or (2) the CARDEAN group, in which the nurse anaesthetist was blinded to CARDEAN application. In addition to conventional signs, an external observer instructed the nurse anaesthetist to administer sufentanil 0.1 µg kg when the CARDEAN crossed a threshold (≥ 60). The primary outcome was the incidence of tachycardia (> 120% of reference heart rate, HR). Non-invasive blood pressure (BP), electrocardiogram (ECG), O saturation-photoplethysmography and the bispectral index (40 < BIS < 60) were monitored. HR and an estimation of beat-by-beat BP changes acquired from photoplethysmography and ECG were combined in an algorithm that detected hypertension followed by tachycardia (index scaled 0-100). Sufentanil 0.1 µg kg was administered when tachycardia, hypertension or movement ("conventional signs") was observed. Data for 66 patients (27 with known hypertension) were analysed. In the CARDEAN group, (a) the dose of sufentanil was higher (control: 0.46 µg kg 100 min, CARDEAN: 0.57 µg kg 100 min, p = 0.016), (b) the incidence rates of tachycardia and untoward events were lower (respectively: - 44%; control: 2.52 events 100 min [1.98-3.22]; CARDEAN: 1.42 [1.03-1.96], p = 0.005, hazard ratio: 0.56; movement, muscular contraction, or coughing: control: 0.74 events 100 min [0.47-1.16]; CARDEAN: 0.31 [0.15-0.62], p = 0.038), and (c) extubation occurred more often in the operating room (control: 76.5%, CARDEAN: 97%, p = 0.016). CARDEAN-titrated opioid administration was associated with a higher dose of sufentanil, a reduction in tachycardia and earlier emergence in ASA I-III patients undergoing major orthopaedic surgery.
观察心血管深度分析（CARDEAN：心血管镇痛深度，法国里昂 Alpha-2 有限公司）是否能降低骨科手术患者的心动过速发生率。共 76 例患者前瞻性随机分为（1）对照组或（2）CARDEAN 组，护士麻醉师对 CARDEAN 的应用情况不知情。除了常规指标外，一名外部观察者指导护士麻醉师在 CARDEAN 超过阈值（≥60）时给予舒芬太尼 0.1μg/kg。主要结局是心动过速（>120%的参考心率，HR）的发生率。监测非侵入性血压（BP）、心电图（ECG）、氧饱和度-光体积描记法和双谱指数（40<BIS<60）。HR 和光体积描记法和心电图获得的逐搏 BP 变化的估计值被组合在一个算法中，该算法检测到高血压后出现心动过速（指数范围为 0-100）。当观察到心动过速、高血压或运动（“常规指标”）时，给予舒芬太尼 0.1μg/kg。对 66 例患者（27 例已知高血压）的数据进行了分析。在 CARDEAN 组中，（a）舒芬太尼的剂量更高（对照组：0.46μg/kg/100min，CARDEAN：0.57μg/kg/100min，p=0.016），（b）心动过速和不良事件的发生率更低（分别为：-44%；对照组：2.52 次/100min[1.98-3.22]；CARDEAN：1.42[1.03-1.96]，p=0.005，风险比：0.56；运动、肌肉收缩或咳嗽：对照组：0.74 次/100min[0.47-1.16]；CARDEAN：0.31[0.15-0.62]，p=0.038），（c）在手术室拔管的患者更多（对照组：76.5%，CARDEAN：97%，p=0.016）。CARDEAN 滴定阿片类药物的应用与舒芬太尼剂量的增加、心动过速的减少以及接受大型骨科手术的 ASA I-III 患者的早期苏醒有关。
