Stasiowski Michał Jan, Starzewska Małgorzata, Niewiadomska Ewa, Król Seweryn, Marczak Kaja, Żak Jakub, Pluta Aleksandra, Eszyk Jerzy, Grabarek Beniamin Oskar, Szumera Izabela, Nycz Michał, Missir Anna, Krawczyk Lech, Jałowiecki Przemysław
Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-555 Katowice, Poland.
Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, Medykow Square 1, 41-200 Sosnowiec, Poland.
Pharmaceuticals (Basel). 2021 May 14;14(5):464. doi: 10.3390/ph14050464.
In patients undergoing colonoscopy procedures (CPs), inadequate dosing of hypnotic drugs (HD) and opioid analgesics (OA) during intravenous sedoanalgesia (ISA) may lead to intraprocedural awareness with recall (IAwR), intraprocedural (IPP) and postprocedural pain (PPP), as well as postoperative nausea and vomiting (PONV). The aim of this study was to evaluate whether the titration of HD and OA based on the observance of changing values of state entropy (SE) and surgical pleth index (SPI) (adequacy of anesthesia-AoA), state entropy alone, or standard practice may reduce the number of adverse events. One hundred and fifty-eight patients were included in the final analysis. The rate of IAwR and IPP was statistically more frequent in patients from the C group in comparison with the AoA and SE groups ( < 0.01 and < 0.05, respectively). In turn, the rate of PPP, PONV, and patients' and operators' satisfaction with ISA between groups was not statistically significant ( > 0.05). Changes in hemodynamic parameters, demand for HD, and OA were statistically significant, but of no clinical value. In patients undergoing CPs under ISA using propofol and FNT, as compared to standard practice, intraprocedural SE monitoring reduced the rate of IAwR and IPP, with no influence on the rate of PPP, PONV, or patients' and endoscopists' satisfaction. AoA guidance on propofol and FNT titration, as compared to SE monitoring only, did not reduce the occurrence of the aforementioned studied parameters, imposing an unnecessary extra cost.
在接受结肠镜检查（CP）的患者中，静脉镇静镇痛（ISA）期间催眠药物（HD）和阿片类镇痛药（OA）剂量不足可能导致术中知晓伴回忆（IAwR）、术中（IPP）和术后疼痛（PPP），以及术后恶心和呕吐（PONV）。本研究的目的是评估基于观察状态熵（SE）和手术容积指数（SPI）变化值（麻醉充分性-AoA）、单独的状态熵或标准操作来滴定HD和OA是否可以减少不良事件的数量。158名患者纳入最终分析。与AoA组和SE组相比，C组患者的IAwR和IPP发生率在统计学上更高（分别为<0.01和<0.05）。而各组之间PPP、PONV的发生率以及患者和操作者对ISA的满意度在统计学上无显著差异（>0.05）。血流动力学参数的变化、HD和OA的需求量在统计学上有显著差异，但无临床意义。在使用丙泊酚和芬太尼进行ISA的CP患者中，与标准操作相比，术中SE监测降低了IAwR和IPP的发生率，对PPP、PONV的发生率或患者及内镜医师的满意度无影响。与仅进行SE监测相比，基于AoA指导滴定丙泊酚和芬太尼并没有减少上述研究参数的发生，还带来了不必要的额外费用。
