Bispectral Index Monitoring during Sedation with Sevoflurane, Midazolam, and Propofol
Bispectral Index Monitoring during Sedation with Sevoflurane, Midazolam, and Propofol
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DOI：
10.1097/00000542-200111000-00019
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发表时间：
2001-11-01
期刊：
影响因子：
8.8
通讯作者：
Kharasch, ED
中科院分区：
文献类型：
--
作者：
Ibrahim, AE;Taraday, JK;Kharasch, ED
背景：双谱指数（BIS）已被用于测量镇静深度。理想情况下，为了指导麻醉管理，不同镇静水平下BIS评分范围不应重叠，BIS应独立于所用药物。本研究评估了BIS预测七氟醚、异丙酚和咪达唑仑之间镇静深度的能力。并对恢复质量进行了比较。接受局部或区域麻醉和镇静手术的患者随机分为七氟醚组（n = 23）、咪达唑仑组（n = 21）和异丙酚组（n = 22）。镇静滴定至观察者警觉性评估-镇静评分3分（对声音反应缓慢）。每5分钟测量一次BIS和观察者的警觉性-镇静评估。比较不同药物间BIS预测概率(p)。通过BIS、数字符号替代和记忆测试评估恢复情况。结果：语音应答者的双谱指数与无应答者显著不同（86 +/- 10 vs. 74 +/- 14，平均值+/-:SD； P < 0.001）。然而，在BIS中观察到广泛的变异性和重叠（25 -75百分位数，应答者vs.无应答者：79-96 vs. 65-83）。七氟醚与异丙酚和咪达唑仑的反应者BIS不同。BIS比七氟醚或咪达唑仑更能预测异丙酚镇静（P- k分别为0.87 +/- 0.11、0.76 +/- 0.01和0.69 +/- 0.02,P < 0.05）。术后10分钟，七氟醚、异丙酚和咪达唑仑患者分别有76%、48%和24%恢复到基线数字符号替代评分（P < 0.05）。七氟醚、异丙酚和咪达唑仑患者的兴奋抑制解除率分别为70%、36%和5% （P < 0.05）。结论：个体BIS评分具有显著的可变性，难以预测镇静深度。BIS与镇静深度的关系可能与麻醉药物无关。两种药物的恢复质量相似，但七氟醚经常出现兴奋。
Background: Bispectral Index (BIS) has been used to measure sedation depth. Ideally, to guide anesthetic management, range of BIS scores at different sedation levels should not overlap, and BIS should be independent of drug used. This study assessed ability of BIS to predict sedation depth between sevoflurane, propofol, and midazolam. Quality of recovery was also compared.Methods. Patients undergoing surgery with local or regional anesthesia and sedation were randomized to sevoflurane (n = 23), midazolam (n = 21), or propofol (n = 22). Sedation was titrated to Observers's Assessment of Alertness-Sedation score of 3 (responds slowly to voice). BIS and Observers's Assessment of Alertness-Sedation were measured every 5 min. BIS prediction probability (P.) was compared between drugs. Recovery was assessed by BIS and Digit Symbol Substitution and memory tests.Results: Bispectral Index of responders to voice was significantly different from nonresponders (86 +/- 10 vs. 74 +/- 14, mean +/-: SD; P < 0.001) However, wide variability and overlap in BIS were observed (25th-75th percentile, responders vs. non-responders: 79-96 vs. 65-83). BIS of responders was different for sevoflurane versus propofol and midazolam. BIS was a better predictor of propofol sedation than sevoflurane or midazolam (P-K = 0.87 +/- 0.11, 0.76 +/- 0.01, and 0.69 +/- 0.02, respectively; P < 0.05). At 10 min after the procedure, 76, 48, and 24% of sevoflurane, propofol, midazolam patients, respectively, returned to baseline Digit Symbol Substitution scores (P < 0.05). Excitement-disinhibition occurred in 70, 36, and 5% of sevoflurane, propofol, and midazolam patients, respectively (P < 0.05).Conclusion: Individual BIS scores demonstrate significant variability, making it difficult to predict sedation depth. The relation between BIS and sedation depth may not be independent of anesthetic agent. Quality of recovery was similar between drugs, but excitement occurred frequently with sevoflurane.