The association of bispectral index values and metrics of cerebral perfusion during cardiopulmonary bypass.
The association of bispectral index values and metrics of cerebral perfusion during cardiopulmonary bypass.
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DOI：
10.1016/j.jclinane.2021.110395
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发表时间：
2021-11
影响因子：
6.7
通讯作者：
Brown CH 4th
中科院分区：
文献类型：
--
作者：
Liu X;Nakano M;Yamaguchi A;Bush B;Akiyoshi K;Lee JK;Koehler RC;Hogue CW;Brown CH 4th
低脑电双频指数（BIS）值与不良术后结局相关。然而，通过滴定麻醉剂给药来优化BIS的试验报告了相互矛盾的结果。一个可能的解释是脑灌注也可能影响BIS，但这种关系的程度尚不清楚。因此，我们研究了在麻醉剂浓度恒定的情况下，BIS是否与心肺转流期间的脑灌注相关。观察性队列研究心脏手术室。纳入了79例心肺转流手术患者。连续监测BIS、平均动脉血压（MAP）、脑血流速度（CBFV）和局部脑氧饱和度（rSO 2），并在持续麻醉期间进行分析。平均血流指数（Mx）计算为MAP和CBFV之间的Pearson相关。自动调节的下限（LLA）被确定为Mx随着血压降低而增加> 0.4的MAP值。术后谵妄使用三维混乱评估方法进行评估。MAP LLA期间的平均BIS较低< LLA compared with BIS when MAP>（平均值49.35 ± 10.40 vs. 50.72 ± 10.04，p=0.002，平均差异=1.38 [标准误：0.42]）。存在剂量反应效应，当MAP降至LLA以下时，BIS成比例降低（所有患者的平均斜率的β = 0.15，95% CI为0.07至0.23，p<0.001）。相比之下，当MAP高于LLA时，BIS相对不变（所有患者的平均斜率β = 0.03，95% CI为-0.02至0.09，p=0.22）。此外，CBFV和rSO 2增加与BIS增加相关。与无谵妄患者相比，术后谵妄患者的平均BIS较低，BIS < 45的持续时间百分比较高。在持续麻醉期间，BIS和脑灌注指标存在相关性，但当MAP降低至LLA以下时，BIS变化的绝对幅度较小。
Low bispectral index (BIS) values have been associated with adverse postoperative outcomes. However, trials of optimizing BIS by titrating anesthetic administration have reported conflicting results. One potential explanation is that cerebral perfusion may also affect BIS, but the extent of this relationship is not clear. Therefore, we examined whether BIS would be associated with cerebral perfusion during cardiopulmonary bypass, when anesthetic concentration was constant. Observational cohort study Cardiac operating room. Seventy-nine patients with cardiopulmonary bypass surgery were included. Continuous BIS, mean arterial blood pressure (MAP), cerebral blood flow velocity (CBFV), and regional cerebral oxygen saturation (rSO2) were monitored, with analysis during a period of constant anesthetic. Mean flow index (Mx) was calculated as Pearson correlation between MAP and CBFV. The lower limit of autoregulation (LLA) was identified as the MAP value at which Mx increased > 0.4 with decreasing blood pressure. Postoperative delirium was assessed using the 3D-Confusion Assessment Method. Mean BIS was lower during periods of MAP < LLA compared with BIS when MAP>LLA (mean 49.35 ± 10.40 vs. 50.72 ± 10.04, p=0.002, mean difference =1.38 [standard error: 0.42]). There was a dose response effect, with the BIS proportionately decreasing as MAP decreased below LLA (β = 0.15, 95% CI for the average slope across all patients 0.07 to 0.23, p<0.001). In contrast, BIS was relatively unchanged when MAP was above LLA (β = 0.03, 95% CI for the average slope across all patients −0.02 to 0.09, p=0.22). Additionally, increasing CBFV and rSO2 were associated with increasing BIS. Patients with postoperative delirium had lower mean BIS and higher percentage of time duration with BIS < 45 compared to patients without delirium. There was an association of BIS and metrics of cerebral perfusion during a period of constant anesthetic administration, but the absolute magnitude of change in BIS as MAP decreased below the LLA was small.
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影响因子：
8.8
作者：
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通讯作者：
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影响因子：
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