Influence of progressive hemorrhage and subsequent cardiopulmonary resuscitation on the bispectral index during isoflurane anesthesia in a swine model
Influence of progressive hemorrhage and subsequent cardiopulmonary resuscitation on the bispectral index during isoflurane anesthesia in a swine model
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DOI：
10.1097/ta.0b013e3182569e9c
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发表时间：
2012-06-01
影响因子：
3.4
通讯作者：
Sato, Shigehito
中科院分区：
文献类型：
--
作者：
Kurita, Tadayoshi;Uraoka, Masahiro;Sato, Shigehito
背景：脑电双频指数用于麻醉深度的测量可能会因失血性休克时的极度低血压而改变。在这项研究中，进行性出血和随后的心肺复苏对脑电双频指数的影响进行了调查控制麻醉depth.METHODS：15只猪通过吸入异氟醚麻醉下脑电双频指数监测。使用逐步出血模型诱导出血性休克，其中在三个30分钟的时间段内去除估计血容量的20%、10%和10%，然后每30分钟去除5%，直到平均动脉压低于10 mm Hg。达到该标准后，进行胸部按压，输注0.2 mg/kg肾上腺素和羟乙基淀粉，持续20分钟或直至平均动脉压超过50 mm Hg。异氟醚的药效学效应在出血前、出血40%后和复苏后进行了检测。结果：复苏前平均（SD）抽取836（78）mL血液。在平均（SD）动脉压为22（3）mm Hg时，脑电双频指数突然下降，并且大多数动物在复苏前表现出等电活动。8只猪复苏，脑电双频指数恢复后的平均动脉压的范围内的时期。异氟醚的药效学效果没有改变后，40%的出血，但复苏后增加，与复苏的时间相关的改变，为rescussion.CONCLUSION：在失血性休克，脑电双频指数仅反映麻醉深度，直到致命性低血压的发展，脑电活动不能持续。从抑郁症中恢复后，异氟醚的效力可根据脑低灌注时间增加。复苏后麻醉药脑电双频指数的增加可反映低灌注所致脑损害的程度。（J Trauma Acute Care Surg.2012;72：1614-1619.版权所有（C）2012 Lippincott威廉姆斯& Wilkins）
BACKGROUND: The bispectral index for measurement of anesthetic depth may be modified by extreme hypotension during hemorrhagic shock. In this study, the influence of progressive hemorrhage and subsequent cardiopulmonary resuscitation on the bispectral index was investigated under controlled anesthetic depth.METHODS: Fifteen swine were anesthetized through inhalation of isoflurane under bispectral index monitoring. Hemorrhagic shock was induced using a stepwise hemorrhage model in which 20%, 10%, and 10% of estimated blood volume were removed over three 30-minute periods and then 5% was removed every 30 minutes until the mean arterial pressure was less than 10 mm Hg. After reaching this criterion, chest compression with 0.2-mg/kg epinephrine and hydroxyethyl starch infusion was performed for 20 minutes or until the mean arterial pressure exceeded 50 mm Hg. The pharmacodynamics of the isoflurane effect was examined before hemorrhage, after 40% bleeding, and after resuscitation.RESULTS: A mean (SD) volume of 836 (78) mL of blood was drained before resuscitation. The bispectral index suddenly decreased at a mean ( SD) arterial pressure of 22 (3) mm Hg and showed isoelectric activity in most animals before resuscitation. Eight pigs were resuscitated, and the bispectral index recovered during a range of periods after recovery of the mean arterial pressure. The pharmacodynamic effect of isoflurane did not change after 40% bleeding but increased after resuscitation, with the alteration correlated with the time for resuscitation.CONCLUSION: In hemorrhagic shock, the bispectral index merely reflects the anesthetic depth until development of lethal hypotension at which brain electrical activity cannot be sustained. After recovery from depression, the potency of isoflurane can increase depending on the cerebral hypoperfusion time. The increased bispectral index for anesthetics after resuscitation might reflect the degree of cerebral damage due to hypoperfusion. (J Trauma Acute Care Surg. 2012;72: 1614-1619. Copyright (C) 2012 by Lippincott Williams & Wilkins)