Comparison of the nociceptive flexion reflex threshold and the bispectral index as monitors of movement responses to noxious stimuli under propofol mono-anaesthesia
Comparison of the nociceptive flexion reflex threshold and the bispectral index as monitors of movement responses to noxious stimuli under propofol mono-anaesthesia
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DOI：
10.1093/bja/aen351
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发表时间：
2009-02-01
影响因子：
9.8
通讯作者：
Baars, J. H.
中科院分区：
文献类型：
--
作者：
von Dincklage, F.;Send, K.;Baars, J. H.
背景。预测麻醉期间对有害刺激的运动反应具有临床重要性。不动参数对催眠和镇痛影响的敏感性可能会带来优势。在这里，伤害性反射可能有用，但有关催眠物质抑制的数据很少。因此，我们比较了异丙酚单麻醉期间RIII反射阈值和脑电双频指数（BIS）对运动反应的预测。方法。其中包括十五名男性志愿者。丙泊酚效应室浓度每15分钟增加1μgml(-1)(最大7μgml(-1))。每 5 分钟，测试对斜方肌挤压和右尺神经 30 秒强直刺激 (80 mA) 的反应。使用自动阈值跟踪系统连续估计 RIII 反射阈值，该系统分析左股二头肌对左腓肠神经刺激的伤害性 RIII 反应。结果。十二名受试者完成了研究。通过减去受试者失去意识后估计的第一个阈值来标准化 RIII 阈值。 RIII 阈值的总体预测概率 P-K 为 0.84，BIS 的总体预测概率 P-K 为 0.86（差异不显着）。结论。异丙酚下对有害刺激的运动反应可以通过 RIII 阈值进行预测，其准确度与 BIS 相当。因此，RIII阈值似乎受到催眠作用的影响。由于 RIII 阈值对镇痛影响的敏感性已得到充分证实，因此当除异丙酚之外还使用镇痛物质时，可以预期 RIII 阈值在预测运动反应方面具有优势。
Background. Prediction of movement responses to noxious stimuli during anaesthesia is of clinical importance. Susceptibility of a parameter of immobility to both hypnotic and analgesic influences could pose an advantage. Here, nociceptive reflexes might be useful, but data regarding the suppression by hypnotic substances are scarce. Therefore, we compared the prediction of movement responses by the RIII reflex threshold and the bispectral index (BIS) during propofol mono-anaesthesia.Methods. Fifteen male volunteers were included. Propofol effect compartment concentration was increased every 15 min in steps of 1 mu g ml(-1) (max 7 mu g ml(-1)). Every 5 min, the reactions to trapezius squeezes and 30 s tetanic stimulations (80 mA) of the right ulnar nerve were tested. The RIII reflex threshold was estimated continuously using an automated threshold tracking system that analyses the nociceptive RIII response at the left biceps femoris muscle to stimulation of the left sural nerve.Results. Twelve subjects completed the study. RIII threshold values were normalized by subtraction of the first threshold that was estimated after the subject's loss of consciousness. The population prediction probability P-K amounted to 0.84 for the RIII threshold and to 0.86 for the BIS (difference not significant).Conclusions. Movement responses to noxious stimuli under propofol can be predicted by the RIII threshold with a comparable accuracy as the BIS. Therefore, the RIII threshold seems to be influenced by hypnotic effects. Since susceptibility of the RIII threshold to analgesic influences is well established, an advantage for the RIII threshold in the prediction of motor responses could be expected when analgesic substances are used in addition to propofol.