熵引导下靶控输注全凭静脉麻醉患者中不必要的自发反应性和爆发抑制：一项前瞻性观察性试验。

Unwanted spontaneous responsiveness and burst suppression in patients undergoing entropy-guided total intravenous anesthesia with target-controlled infusion: An observational prospective trial.

作者信息

Linassi Federico, Kreuzer Matthias, Kratzer Stephan, Olivieri Sara, Zanatta Paolo, Schneider Gerhard, Carron Michele

机构信息

Department of Pharmaceutical and Pharmacological Sciences, Università degli Studi di Padova, via Marzolo 5, 35131, Padova, Italy; Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Piazzale Ospedale 1, Treviso 31100, Italy.

Department of Anesthesiology and Intensive Care, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, München 81675, Germany.

出版信息

J Clin Anesth. 2023 Jun;86:111045. doi: 10.1016/j.jclinane.2022.111045. Epub 2023 Jan 19.

DOI:10.1016/j.jclinane.2022.111045

PMID:36680980

Abstract

STUDY OBJECTIVE

To estimate the incidence of unwanted spontaneous responsiveness and burst suppression (BSupp) in patients undergoing state entropy (SE) and surgical pleth index (SPI)-guided total intravenous anesthesia (TIVA) with target-controlled infusion (TCI).

DESIGN

Observational, prospective, single-center study.

SETTINGS

Operating room.

PATIENTS

107 adult (<65 years) and elderly (≥65 years) women undergoing breast surgery.

INTERVENTIONS

Propofol-remifentanil TIVA-TCI-guided by SE for depth of anesthesia monitoring (target value 40-60) and SPI for antinociception monitoring (target value 20-50) without neuromuscular blockade.

MEASUREMENTS

Age; body mass index; American Society of Anesthesiologists physical status classification; concentration at the effect site of propofol (CeP) and remifentanil (CeR) at loss of responsiveness (LoR), median during anesthesia maintenance (MdM), and at return of responsiveness (RoR); propofol infusion duration; incidence of postoperative delirium (POD) with Confusing Assessment Method for the Intensive Care Unit.

MAIN RESULTS

During SE-SPI-guided TIVA-TCI, 13.1% of patients showed unwanted spontaneous responsiveness, whereas 45.8% showed BSupp. Unwanted spontaneous responsiveness was observed mainly in adults (p < 0.05), and higher CeP RoR (p < 0.05) was registered. BSupp was observed mainly in patients showing a lower CeP MdM (p < 0.01) and CeP RoR (p < 0.05). Unwanted spontaneous responsiveness and BSupp were not associated with significant differences in CeRs. An age-related hysteresis effect was observed, resulting in higher CeP LoR than CeP RoR (p < 0.001). 12.2% of patients showed POD. Only preoperative serum albumin was associated with increased likelihood of POD (p = 0.046).

CONCLUSIONS

The SE-SPI-guided TIVA-TCI did not prevent unwanted spontaneous responsiveness and BSupp. CeP RoR may be used as a proxy for anesthetic sensitivity.

摘要

研究目的

评估在接受状态熵（SE）和手术容积指数（SPI）引导下的靶控输注（TCI）全静脉麻醉（TIVA）的患者中，非预期的自主反应性和爆发抑制（BSupp）的发生率。

设计

观察性、前瞻性、单中心研究。

地点

手术室。

患者

107例接受乳房手术的成年（<65岁）和老年（≥65岁）女性。

干预措施

丙泊酚-瑞芬太尼TIVA-TCI，以SE指导麻醉深度监测（目标值40-60），以SPI指导抗伤害感受监测（目标值20-50），不使用神经肌肉阻滞剂。

测量指标

年龄；体重指数；美国麻醉医师协会身体状况分级；丙泊酚（CeP）和瑞芬太尼（CeR）在意识消失（LoR）时、麻醉维持期中位数（MdM）以及意识恢复（RoR）时效应部位的浓度；丙泊酚输注持续时间；采用重症监护病房谵妄评估方法评估的术后谵妄（POD）发生率。

主要结果

在SE-SPI引导的TIVA-TCI期间，13.1%的患者出现非预期的自主反应性，而45.8%的患者出现BSupp。非预期的自主反应性主要在成年人中观察到（p<0.05），且记录到较高的CeP RoR（p<0.05）。BSupp主要在CeP MdM较低（p<0.01）和CeP RoR较低（p<0.05）的患者中观察到。非预期的自主反应性和BSupp与CeRs的显著差异无关。观察到与年龄相关的滞后效应，导致CeP LoR高于CeP RoR（p<0.001）。12.2%的患者出现POD。只有术前血清白蛋白与POD发生可能性增加相关（p=0.046）。