The effects of cognitive impairment on anaesthetic requirement in the elderly
The effects of cognitive impairment on anaesthetic requirement in the elderly
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DOI：
10.1097/eja.0b013e32835475c6
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发表时间：
2012-07-01
影响因子：
3.6
通讯作者：
Ersoy, Mehmet O.
中科院分区：
文献类型：
--
作者：
Erdogan, Mehmet A.;Demirbilek, Semra;Ersoy, Mehmet O.
背景痴呆患者清醒时的脑电双频指数(BIS)低于年龄匹配的健康对照组。目的比较认知功能障碍患者与认知功能正常患者的BIS和异丙酚诱导剂量。这项研究还评估了老年人认知障碍对手术中麻醉剂用量和麻醉苏醒的影响。设计和设置这项随机对照研究在一所大学医院进行。将年龄在65岁以上、ASA I~II级、择期骨科手术的患者分为两组，根据简明精神状态检查评分分为两组：25分及以上(第1组)或21分及以下(第2组)。所有患者在瑞芬太尼0.5mgKg(-1)min(-1)输注开始后给予异丙酚0.5mgkg(-1)。在递增剂量异丙酚至意识丧失后，于75mU·g·kg~(-1)·min(-1)开始输注异丙酚。术中调整异丙酚和瑞芬太尼的输注剂量，使BIS值保持在45~60之间。术前、术后24 h评定主要观察指标MMSE评分。结果两组患者术前简易智能状态检查评分分别为26.8±-1.6分和16.6±-4.2分。第1组(26.6+/-1.5)和第2组(15.6+/-4.3)术后24小时恢复至基线值。诱导前，第1组45例患者中有4例(8.9%)BIS值小于93，而第2组47例患者中有13例(27.7%)BIS值低于93(P=0.02)。麻醉诱导前、意识丧失时、停药后3min、5min、拔管前，第2组的BIS值均显著低于第1组(P<0.05)。异丙酚诱导剂量2组低于1组(P=0.02)。2组患者睁眼时间明显长于1组(P=0.03)。结论认知功能障碍患者的基线BIS值低于认知功能正常者。前者异丙酚用量少，睁眼时间长。根据我们在恢复期的发现，我们建议在一般人群中适当麻醉的推荐目标BIS值对于认知障碍患者是不合适的。欧洲麻醉学杂志2012；29：326-331
Context Patients with dementia have a lower bispectral index score (BIS) when awake than age-matched healthy controls.Objectives The primary aim was to compare the BIS and the dose of propofol required for induction in patients suffering from cognitive impairment with that in those who had normal cognitive function. This study also evaluated the effects of cognitive impairment in the elderly on anaesthetic agent consumption during surgery and on emergence from anaesthesia.Design and setting This randomised controlled study was carried out in a university hospital. Patients over 65 years of age, ASA I-II and scheduled for elective orthopaedic procedures were allocated to one of two groups.Interventions Patients (n = 92) were allocated according to their Mini Mental State Examination score: 25 or higher (group 1) or 21 or less (group 2). All patients received propofol 0.5 mgkg(-1) following the commencement of a remifentanil infusion at 0.5 mu gkg(-1) min(-1). After incremental doses of propofol up to loss of consciousness, a propofol infusion was started at 75 mu gkg(-1) min(-1). Propofol and remifentanil infusion doses were adjusted to keep the BIS value between 45 and 60 during surgery.Main outcome measure MMSE score was evaluated 24 h before and after surgery. The anaesthetic consumption, mean arterial pressure, HR and BIS values of the patients were recorded.Results Before surgery, mean Mini Mental State Examination scores were 26.8 +/- 1.6 and 16.6 +/- 4.2 in group 1 and 2, respectively. These returned to baseline value 24 h after surgery in group 1 (26.6 +/- 1.5) and group 2 (15.6 +/- 4.3). Before induction, four of 45 patients (8.9%) in group 1 had a BIS value less than 93 compared with 13 of 47 (27.7%) in group 2 (P = 0.02). The mean BIS value was significantly lower in group 2 than in group 1 before induction, during loss of consciousness, 3 and 5 min after discontinuation of the anaesthetic agents and before extubation (P < 0.05). The induction dose of propofol was lower in group 2 than in group 1 (P = 0.02). The eye opening time was significantly longer in group 2 than in group 1 (P = 0.03).Conclusion The baseline BIS value was lower in patients with cognitive impairment than in those with normal cognitive function. The former received less propofol during induction and eye opening time was longer. On the basis of our findings from the recovery period, we suggest that the recommended target BIS value for adequate anaesthesia in the general population is inappropriate for patients with cognitive impairment. Eur J Anaesthesiol 2012; 29:326-331