Department of Anesthesiology and Pain Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est de l'Ile de Montréal, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada; Department of Anesthesiology and Pain Medicine - Université de Montréal, 2900 Bd Edouard-Montpetit, Montréal, QC, H3T 1J4, Canada.
Department of Anesthesiology and Pain Medicine, Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est de l'Ile de Montréal, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada.
Anaesth Crit Care Pain Med. 2022 Jun;41(3):101081. doi: 10.1016/j.accpm.2022.101081. Epub 2022 Apr 25.
Currently, nociception monitors are not part of standard anaesthesia care. We investigated whether combined intraoperative nociception (NOL index) and anaesthesia (BIS index) monitoring during general anaesthesia would reduce anaesthetics consumption and enhance intraoperative safety and postoperative recovery when compared to standard of care monitoring (SOC).
In this randomised study, we included 60 patients undergoing colonic surgery under desflurane/remifentanil anaesthesia and epidural analgesia. Patients received either standard monitoring or combined BIS + NOL index monitoring. In the monitored group, remifentanil infusion was titrated to achieve a NOL index below 20. Desflurane was adjusted to BIS values (45-55). In the SOC group, remifentanil and desflurane were titrated on vital signs and MAC. The primary outcome was intraoperative desflurane consumption.
Fifty-five patients were analysed. Desflurane administration was reduced in the monitored group from 0.25 ± 0.05 to 0.20 ± 0.06 mL kg h (p < 0.001). The cumulative time with a BIS under 40 was significantly higher in the SOC group with a median time of 12.6 min (95% CI: 0.6-80.0) versus 2.0 min (95% CI: 0.3-5.83) (p = 0.023). Time for extubation was significantly shorter in the monitored group: 4.4 min (95% CI: 2.4-4.9) versus 6.28 min (95% IC: 5.0-8.2) (p = 0.003). We observed no differences in remifentanil or phenylephrine requirements during anaesthesia or in postoperative outcome measures, such as postoperative pain, opioid consumption, neurocognitive recovery.
Combined intraoperative monitoring of anaesthesia and nociception during colonic surgery resulted in less desflurane consumption and quicker extubation time compared to standard clinical care monitoring.
目前，疼痛监测并不是标准麻醉护理的一部分。我们研究了在全身麻醉期间进行术中疼痛（NOL 指数）和麻醉（BIS 指数）联合监测是否与标准护理监测（SOC）相比，可以减少麻醉药物的消耗，提高术中安全性和术后恢复。
在这项随机研究中，我们纳入了 60 例接受地氟醚/瑞芬太尼麻醉和硬膜外镇痛的结肠手术患者。患者接受标准监测或 BIS+NOL 指数联合监测。在监测组中，瑞芬太尼输注被滴定以达到 NOL 指数低于 20。地氟醚根据 BIS 值（45-55）进行调整。在 SOC 组中，瑞芬太尼和地氟醚根据生命体征和 MAC 进行滴定。主要结局是术中地氟醚消耗。
55 例患者进行了分析。监测组地氟醚的用量从 0.25±0.05 降至 0.20±0.06 mL·kg·h（p<0.001）。SOC 组中 BIS 值低于 40 的累积时间明显更长，中位数时间为 12.6 分钟（95%CI：0.6-80.0）与 2.0 分钟（95%CI：0.3-5.83）（p=0.023）。监测组的拔管时间明显缩短：4.4 分钟（95%CI：2.4-4.9）与 6.28 分钟（95%IC：5.0-8.2）（p=0.003）。我们在麻醉期间没有观察到瑞芬太尼或苯肾上腺素的需求或术后结果测量（如术后疼痛、阿片类药物消耗、神经认知恢复）的差异。
与标准临床护理监测相比，在结肠手术期间进行麻醉和疼痛的术中联合监测可减少地氟醚的消耗，并加快拔管时间。
