Wilder-Smith O H, Hagon O, Tassonyi E
Department of Anaesthesiology, Geneva University Hospital, Switzerland.
Br J Anaesth. 1995 Oct;75(4):441-6. doi: 10.1093/bja/75.4.441.
We studied EEG arousal after laryngoscopy and intubation with standardized bolus induction of anaesthesia. Twenty patients were prospectively allocated randomly to induction with propofol 3 mg kg-1 (n = 10) or thiopentone (6 mg kg-1 (n = 10) and 50% nitrous oxide in oxygen. Neuromuscular block was produced with vecuronium 0.2 mg kg-1 given 30 s after induction. Three minutes after induction, laryngoscopy was performed for 60 s, with intubation at 3 min 30 s, and study end at 5 min. Nociception to laryngoscopy and intubation was followed by loss of low (relative delta activity change: thiopentone -30%, propofol -7%; P < 0.05) and a shift to higher frequency EEG activity (beta activity change: thiopentone +647%, propofol +61%; P < 0.05). This EEG arousal was greater in the thiopentone group, despite the fact that EEG depression was similar to that produced by propofol before laryngoscopy and intubation. Propofol and thiopentone in combination with nitrous oxide had similar cortical depressant effects, but propofol appeared to depress subcortical nociceptive processing more than thiopentone. While the degree of cortical EEG depression seems less useful for predicting reaction to subsequent nociception, EEG arousal reactions may prove suitable for monitoring intra-anaesthetic nociception and its modulation.
我们采用标准化大剂量麻醉诱导方法，研究了喉镜检查和气管插管后的脑电图觉醒情况。20例患者被前瞻性随机分配，分别用3mg/kg丙泊酚（n = 10）或硫喷妥钠（6mg/kg，n = 10）诱导麻醉，并吸入50%氧化亚氮和氧气。诱导后30秒给予0.2mg/kg维库溴铵以产生神经肌肉阻滞。诱导3分钟后，进行60秒的喉镜检查，在3分30秒时进行气管插管，5分钟时研究结束。喉镜检查和气管插管引起的伤害性感受之后，出现低频丧失（相对δ活动变化：硫喷妥钠组-30%，丙泊酚组-7%；P < 0.05）以及脑电图活动向高频转移（β活动变化：硫喷妥钠组+647%，丙泊酚组+61%；P < 0.05）。尽管在喉镜检查和气管插管前硫喷妥钠组脑电图抑制与丙泊酚组相似，但硫喷妥钠组的这种脑电图觉醒更明显。丙泊酚和硫喷妥钠联合氧化亚氮具有相似的皮质抑制作用，但丙泊酚似乎比硫喷妥钠更能抑制皮质下伤害性感受处理。虽然皮质脑电图抑制程度对于预测对随后伤害性感受的反应似乎用处不大，但脑电图觉醒反应可能适用于监测麻醉期间的伤害性感受及其调节。
