Xin Yueyang, Ma Li, Xie Tianli, Liang Yuhui, Ma Miao, Chu Tiantian, Liu Cheng, Xu Aijun
Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
School of Information Engineering, Wuhan University of Technology, Wuhan, Hubei, China.
Front Med (Lausanne). 2023 Aug 7;10:1128030. doi: 10.3389/fmed.2023.1128030. eCollection 2023.
Bispectral index (BIS), an index used to monitor the depth of anesthesia, can be interfered with by the electromyogram (EMG) signal. The 95% spectral edge frequency (SEF95) also can reflect the sedation depth. Remimazolam in monitored anesthesia care results in higher BIS values than propofol, though in the same sedation level assessed by Modified Observers Assessment of Alertness and Sedation (MOAA/S). Our study aims to illustrate whether EMG is involved in remimazolam causing higher BIS value than propofol preliminarily and to explore the correlations among BIS, EMG, and SEF95 under propofol and remimazolam anesthesia.
Twenty-eight patients were randomly divided into propofol (P) and remimazolam (RM) groups. Patients in the two groups received alfentanil 10 μg/kg, followed by propofol 2 mg/kg and remimazolam 0.15 mg/kg. Blood pressure (BP), heart rate (HR), and oxygen saturation (SpO) were routinely monitored. The BIS, EMG, and SEF95 were obtained through BIS VISTATM. The primary outcomes were BIS, EMG, and the correlation between BIS and EMG in both groups. Other outcomes were SEF95, the correlation between BIS and SEF95, and the correlation between EMG and SEF95. And all the statistical and comparative analysis between these signals was conducted with SPSS 26.0 and GraphPad Prism 8.
BIS values, EMG, and SEF95 were significantly higher in the RM group than in the P group (all < 0.001). There was a strong positive correlation between BIS and EMG in the RM group ( = 0.416). Nevertheless, the BIS in the P group showed a weak negative correlation with EMG ( = -0.219). Both P ( = 0.787) and RM group ( = 0.559) had a reasonably significant correlation coefficient between BIS and SEF95. SEF95 almost did not correlate with EMG in the RM group ( = 0.101).
Bispectral index can be interfered with high EMG intensity under remimazolam anesthesia. However, EMG can hardly affect the accuracy of BIS under propofol anesthesia due to low EMG intensity and a weak negative correlation between EMG and BIS. Moreover, SEF95 may have a great application prospect in predicting the sedation condition of remimazolam.
脑电双频指数（BIS）是一种用于监测麻醉深度的指标，可受到肌电图（EMG）信号的干扰。95%频谱边缘频率（SEF95）也能反映镇静深度。在监护麻醉中，瑞马唑仑导致的BIS值高于丙泊酚，尽管在通过改良的警觉与镇静观察评分（MOAA/S）评估的相同镇静水平下。本研究旨在初步阐明EMG是否参与瑞马唑仑导致BIS值高于丙泊酚的过程，并探讨丙泊酚和瑞马唑仑麻醉下BIS、EMG和SEF95之间的相关性。
28例患者随机分为丙泊酚（P）组和瑞马唑仑（RM）组。两组患者均先静脉注射阿芬太尼10μg/kg，随后分别静脉注射丙泊酚2mg/kg和瑞马唑仑0.15mg/kg。常规监测血压（BP）、心率（HR）和血氧饱和度（SpO）。通过BIS VISTATM获取BIS、EMG和SEF95。主要观察指标为两组的BIS、EMG以及BIS与EMG之间的相关性。其他观察指标为SEF95、BIS与SEF95之间的相关性以及EMG与SEF95之间的相关性。所有这些信号之间的统计和比较分析均使用SPSS 26.0和GraphPad Prism 8进行。
RM组的BIS值、EMG和SEF95均显著高于P组（均P<0.001）。RM组中BIS与EMG之间存在强正相关（r=0.416）。然而，P组中BIS与EMG呈弱负相关（r=-0.219）。P组（r=0.787）和RM组（r=0.559）中BIS与SEF95之间的相关系数均具有合理的显著性。RM组中SEF95与EMG几乎无相关性（r=0.101）。
瑞马唑仑麻醉下，高EMG强度可干扰脑电双频指数。然而，由于EMG强度较低且EMG与BIS之间呈弱负相关，丙泊酚麻醉下EMG几乎不影响BIS的准确性。此外，SEF95在预测瑞马唑仑的镇静状态方面可能具有较大的应用前景。
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