Evaluation of the electroencephalographic bispectral index during fentanyl-midazolam anaesthesia for cardiac surgery.: Does it predict haemodynamic responses during endotracheal intubation and sternotomy?
Evaluation of the electroencephalographic bispectral index during fentanyl-midazolam anaesthesia for cardiac surgery.: Does it predict haemodynamic responses during endotracheal intubation and sternotomy?
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DOI：
10.1046/j.1365-2346.1999.00551.x
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发表时间：
1999-09-01
影响因子：
3.6
通讯作者：
Booij, LHDJ
中科院分区：
文献类型：
--
作者：
Driessen, JJ;Harbers, JBM;Booij, LHDJ
脑电双频指数是根据脑电得出的一个值，被认为是衡量麻醉效果的指标。本研究的目的是评估咪达唑仑-芬太尼麻醉用于心脏手术时的脑电双频指数，以预测气管插管和胸骨切开时收缩压升高的可能作用。在机构批准后，15名自愿接受择期心脏手术的患者被选为研究对象。芬太尼负荷量7.5~10mgkg(-1)，咪达唑仑0.15 mg kg(-1)，潘库溴铵0.1 mg kg(-1)。在切开胸骨前再静脉注射芬太尼10~12.5 mg·kg~(-1)，开始维持芬太尼4~6 mg·kg~(-1)·h~(-1)和咪达唑仑0.1 mg·kg~(-1)·h~(-1)的输注速度，并根据临床和血流动力学反应指导手术。麻醉的控制从来不是基于脑电双频指数的值。麻醉诱导后平均脑电双频指数由基线的95.7(3.1)降至59.5(12.0)，然后一直维持在70以下。然而，尽管芬太尼和咪达唑仑的剂量是标准化的，但脑电双频指标值存在重要的个体间差异。插管前和切开前的脑电双频指数值与气管插管时和胸骨切开时的收缩压变化无明显相关性。总而言之，鉴于咪达唑仑和芬太尼的临床疗效差异很大，双频指数值的研究对象间差异很大，应该进一步研究。双频指数与血流动力学反应之间缺乏显著相关性，提示双频指数作为监测麻醉深度的有用指标，在心脏手术患者咪达唑仑和芬太尼复合全凭静脉麻醉期间，并不是一个非常可靠的监测全麻充分性的指标。
The bispectral index, a value derived from the electroencephalogram, has been proposed as a measure of anaesthetic effect. The aim of the present study was to evaluate the bispectral index during midazolam-fentanyl anaesthesia for cardiac surgery for its possible role as a predictor of increases in systolic blood pressure during endotracheal intubation and sternotomy. After institutional approval 15 consenting patients, scheduled for elective cardiac surgery, were selected for the study. Anaesthesia was induced in all patients with a loading dose of fentanyl 7.5-10 mu g kg(-1), midazolam 0.15 mg kg(-1) and pancuronium 0.1 mg kg(-1). After a further bolus dose of fentanyl 10-12.5 mu g kg(-1) prior to the start of incision and sternotomy, maintenance infusion rates of fentanyl 4-6 mu g kg(-1) h(-1) and midazolam 0.1 mg kg(-1) h(-1) were started and continued through surgery at the discretion of the anaesthetist and guided by the presenting clinical and haemodynamic responses. The control of anaesthesia was never based on the value of the bispectral index. The mean bispectral index value decreased from 95.7 (3.1) at base-line to 59.5 (12.0) after induction of anaesthesia and then remained below 70 throughout surgery. However, there was an important interindividual variability in bispectral index values despite standardized dosages of fentanyl and midazolam. There was no significant correlation between the bispectral index values in the pre-intubation and pre-incision period and the changes in systolic blood pressure during endotracheal intubation and sternotomy, respectively. In conclusion, the large intersubject variability in the bispectral index values should be investigated further in the light of the great variability in the clinical effects of midazolam and fentanyl. The lack of significant correlation between the bispectral index values and the haemodynamic responses suggest that the bispectral index, which is a helpful monitor of anaesthetic depth, is not a very reliable monitor of global anaesthetic adequacy during total intravenous anaesthesia with a combination of midazolam and fentanyl in cardiac surgical patients.