Sebel P S, Lang E, Rampil I J, White P F, Cork R, Jopling M, Smith N T, Glass P S, Manberg P
Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia 30335-3801, USA.
Anesth Analg. 1997 Apr;84(4):891-9. doi: 10.1097/00000539-199704000-00035.
Bispectral analysis (BIS) of the electroencephalogram (EEG) has been shown in retrospective studies to predict whether patients will move in response to skin incision. This prospective multicenter study was designed to evaluate the real-time utility of BIS in predicting movement response to skin incision using a variety of general anesthetic techniques. Three hundred patients from seven study sites received an anesthetic regimen expected to give an approximately 50% movement response at skin incision. EEG was continuously recorded via an Aspect B-500 monitor and BIS was calculated in real time from bilateral frontocentral channels displayed on the monitor. Half of the patients were randomized to a treatment group in which anesthetic drug doses were increased to produce a lower BIS. In the control group, BIS was recorded, but no action taken on the data displayed. A determination of movement in response to skin incision was made in the 2 min succeeding incision. Retrospective pharmacodynamic modeling was performed using STANPUMP to estimate effect-site concentrations of intravenously administered anesthetics. BIS values were significantly higher in the control group (66 +/- 19) versus the BIS-guided group, in which additional anesthesia was administered to produce a lower BIS (51 +/- 19). The movement response rate was significantly higher in the control group at 43% compared with 13% in the BIS-guided group, but response rates were low at sites which used larger doses of opioids. Logistic regression analysis showed that BIS, estimated opioid effect-site concentrations, and heart rate (in that order) were the best predictors of movement at skin incision. This study demonstrates that dosing anesthetic drugs to lower BIS values achieves a lower probability of movement in response to surgical stimulation. BIS is a significant predictor of patient response to incision, but the utility of the BIS depends on the anesthetic technique being used. When drugs such as propofol or isoflurane are used as the primary anesthetic, changes in BIS correlate with the probability of response to skin incision. When opioid analgesics are used, the correlation to patient movement becomes much less significant, so that patients with apparently "light" EEG profiles may not move or otherwise respond to incision. Therefore, the adjunctive use of opioid analgesics confounds the use of BIS as a measure of anesthetic adequacy when movement response to skin incision is used as the primary end point.
脑电图（EEG）的双谱分析（BIS）在回顾性研究中已被证明可预测患者是否会对皮肤切口做出动作反应。这项前瞻性多中心研究旨在评估BIS在使用多种全身麻醉技术预测对皮肤切口的动作反应方面的实时效用。来自七个研究地点的300名患者接受了预期在皮肤切口时产生约50%动作反应的麻醉方案。通过Aspect B - 500监测仪连续记录脑电图，并根据监测仪上显示的双侧额中央通道实时计算BIS。一半患者被随机分配到治疗组，在该组中增加麻醉药物剂量以产生较低的BIS。在对照组中，记录BIS，但不对显示的数据采取任何措施。在切口后的2分钟内确定对皮肤切口的动作情况。使用STANPUMP进行回顾性药效学建模，以估计静脉注射麻醉剂的效应室浓度。对照组的BIS值（66±19）显著高于BIS引导组，在BIS引导组中给予额外麻醉以产生较低的BIS（51±19）。对照组的动作反应率显著更高，为43%，而BIS引导组为13%，但在使用较大剂量阿片类药物的地点反应率较低。逻辑回归分析表明，BIS、估计的阿片类药物效应室浓度和心率（按此顺序）是皮肤切口时动作的最佳预测指标。这项研究表明，调整麻醉药物剂量以降低BIS值可降低对手术刺激做出动作的可能性。BIS是患者对切口反应的重要预测指标，但BIS的效用取决于所使用的麻醉技术。当使用丙泊酚或异氟烷等药物作为主要麻醉剂时，BIS的变化与对皮肤切口反应的可能性相关。当使用阿片类镇痛药时，与患者动作的相关性变得不那么显著，因此脑电图表现明显“浅”的患者可能不会对切口做出动作或其他反应。因此，当以对皮肤切口的动作反应作为主要终点时，阿片类镇痛药的辅助使用会混淆BIS作为麻醉充分性衡量指标的使用。
