Electroencephalographic monitoring during sevoflurane anaesthesia in an amyotrophic lateral sclerosis patient with locked-in state.
Electroencephalographic monitoring during sevoflurane anaesthesia in an amyotrophic lateral sclerosis patient with locked-in state.
复制标题
锁定状态肌萎缩侧索硬化症患者七氟醚麻醉期间的脑电图监测。
DOI：
10.1016/j.jocn.2017.04.042
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发表时间：
2017
影响因子：
2
通讯作者：
Tanaka A.
中科院分区：
文献类型：
--
作者：
Hayashi K;Araki R;Tanaka A.
近年来，肌萎缩侧索硬化症（ALS）患者的认知能力受损沿着运动神经元的神经变性。据报道，终末期ALS患者的脑电图（EEG）显示出基于神经元网络调制的特定特征，不同于其他认知障碍和痴呆患者的EEG。然而，脑电图的终末期ALS患者在麻醉期间尚未有报道。一位64岁男性肌萎缩侧索硬化症（ALS）闭锁状态（LIS）患者，在气管切开正压通气（TPPV）和肠内营养支持下9年，接受了预定的全身麻醉，以修复下颌骨骨折。他可以眨眼和睁开眼睛，但很少在指令下睁开或闭上眼睛。七氟醚麻醉诱导下连续脑电图监测与脑电双频指数（BIS），这是常用的检查麻醉水平。在麻醉期间出现了具有较低峰值频率和高振幅的突出的α振荡，不同于一般认知功能障碍患者的EEG特征。相反，BIS反映了ALS患者的七氟烷浓度，与健康人相似，BIS监测可用于估计麻醉深度。在这一罕见的病例报告中发现的突出的α振荡可能表明进行性ALS患者麻醉期间功能性神经元网络系统的调制，其方式与典型的痴呆患者完全不同。脑电图异常在本ALS患者并没有影响BIS监测的可用性。
Recently, the cognitive abilities of patients with amyotrophic lateral sclerosis (ALS) have been found to be impaired along with the neurodegeneration of motor neurons. Electroencephalography (EEG) of end-stage ALS patients has reportedly shown specific features based on neuronal network modulations, differing from EEG of other patients with cognitive failure and dementia. However, EEG of end-stage ALS patients during anaesthesia has not yet been reported. A 64-year-old male ALS patient with locked-in state (LIS), supported by tracheostomy positive-pressure ventilation (TPPV) and enteral nourishment for 9 years, underwent scheduled general anaesthesia for repair of a fractured mandible. He could blink and open his eyes, but seldom opened or closed his eyes on instruction. Sevoflurane anaesthesia was induced under continuous EEG monitoring with bispectral index (BIS), which is commonly used to examine the level of anaesthesia. Prominent alpha oscillations with lower peak frequency and high amplitude appeared during anaesthesia, differing from the characteristics of EEG seen in patients with general cognitive failure. Conversely, BIS reflected the sevoflurane concentration in this ALS patient, similar to healthy individuals, and BIS monitoring was useful for estimating the depth of anaesthesia. The prominent alpha oscillation revealed in this rare case report may suggest modulation of the functional neuronal network system during anaesthesia in patients with progressive ALS, in a manner quite different from typical dementia patients. EEG abnormalities in the present ALS patient did not influence the availability of BIS monitoring.