Polievoi Yehor, Grafmans Daniel, Skliar Mariia, Kossatz Andrea, Soukup Jens, Kellner Patrick, Herzog Beatrice, Herzog Michael
Department of Otorhinolaryngology, Head and Neck Surgery Carl-Thiem-Klinikum gGmbH Cottbus Germany.
Department of Otorhinolaryngology, Head and Neck Surgery Klinikum Barnim, Werner-Forßmann-Krankenhaus Eberswalde Germany.
Laryngoscope Investig Otolaryngol. 2024 Jun 17;9(3):e1258. doi: 10.1002/lio2.1258. eCollection 2024 Jun.
The course of sedation during drug-induced sleep endoscopy (DISE) depends on the application pattern of the sedative drug. The depth of sedation should imitate light and deep sleep as well. Moreover, there should be as many breathing cycles as possible available for observation during light and deep sedation. The aim of the study was to evaluate different rates of propofol application with respect to the achieved depth and length of the course of sedation.
Sixty-three consecutive patients with obstructive sleep apnea and/or snoring undergoing DISE were randomly sedated by propofol perfusion at seven different application patterns: 14, 16, 18, 19, 20, 22 mg/kg/h (0.233, 0.267, 0.3, 0.317, 0.333, 0.367 mg/kg/min) per perfusor and individual bolus application 10 mg each. Sedation depth was monitored by BiSpectral Index™ (BIS). The influence of baseline parameters and the courses of sedation were analyzed.
The application rate was the only factor that influenced the depth of sedation. Basic parameters (gender, age, body mass index, apnea-hypopnea index) had no influence on the depth of sedation. The sedation depth was dependent on the rate of propofol application. Regimes at 14 and 16 mg/kg/h as well as bolus application did not reach BIS levels below 50 representing deep sleep. Propofol doses of more than 20 mg/kg/h led to rapid decreases of sedation levels below deep sleep niveau. Propofol rates between 18 and 20 mg/kg/h enable BIS levels below 50 representing deep sleep and providing enough breathing cycles for observation.
Lower application rates of propofol provide slower courses of sedation and shallower depths of sedation. A rate of 14 mg/kg/h might be appropriate to reach a sedation plateau at light sleep. A rate of 18 mg/kg/h leads to a sedation, corresponding to deep sleep. The combination of both rates might be a suitable pattern for performing sedation-controlled DISE.
2: Randomized trial.
药物诱导睡眠内镜检查（DISE）期间的镇静过程取决于镇静药物的应用模式。镇静深度应模拟浅睡眠和深睡眠。此外，在浅镇静和深镇静期间应有尽可能多的呼吸周期可供观察。本研究的目的是评估不同丙泊酚应用速率对镇静深度和持续时间的影响。
63例连续接受DISE的阻塞性睡眠呼吸暂停和/或打鼾患者，通过丙泊酚灌注以七种不同的应用模式随机进行镇静：每个灌注器14、16、18、19、20、22mg/kg/h（0.233、0.267、0.3、0.317、0.333、0.367mg/kg/min）以及每次10mg的单次推注。通过脑电双频指数（BiSpectral Index™，BIS）监测镇静深度。分析基线参数和镇静过程的影响。
应用速率是影响镇静深度的唯一因素。基本参数（性别、年龄、体重指数、呼吸暂停低通气指数）对镇静深度无影响。镇静深度取决于丙泊酚的应用速率。14和16mg/kg/h的方案以及单次推注未达到代表深睡眠的BIS水平低于50。超过20mg/kg/h的丙泊酚剂量导致镇静水平迅速降至深睡眠水平以下。18至20mg/kg/h的丙泊酚速率可使BIS水平低于50，代表深睡眠并提供足够的呼吸周期用于观察。
较低的丙泊酚应用速率导致较慢的镇静过程和较浅的镇静深度。14mg/kg/h的速率可能适合在浅睡眠时达到镇静平台期。18mg/kg/h的速率导致的镇静相当于深睡眠。两种速率的组合可能是进行镇静控制DISE的合适模式。
2：随机试验。
