Bispectral index compared with the isolated forearm technique
Bispectral index compared with the isolated forearm technique
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双频指数与孤立前臂技术的比较
DOI：
10.1111/anae.12336
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发表时间：
2013
期刊：
影响因子：
10.7
通讯作者：
M. Wiles
中科院分区：
文献类型：
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作者：
J. Andrzejowski;M. Wiles
低，并且应立即解决图 3 中所示的攀升/上升 BIS 轨迹。然而，研究方案包括等待更长的时间，看看患者是否进一步醒来并与主治临床医生进行“握手对话”。我们认为，这是不可接受的，因为如果可以进行轻度麻醉，则应寻找原因（例如镇痛不足），并立即相应地调整麻醉剂。我们认为 Russell 应该在他的讨论中明确表示，不鼓励接受 BIS 值 > 60，除非患者血流动力学稳定并且麻醉浓度在临床上足够（当一个例子显示异丙酚目标浓度 < 2 lg.ml 时，在本研究中这是值得怀疑的）。孤立前臂技术，如果用于其最初目的而不是简单地测试概率边界，无疑是监测麻醉下清醒状态的黄金标准；然而，它不太可能被广泛采用到常规临床实践中。作为术中 BIS 监测的常规用户，我们敦促所有读者不要孤立地看待 Russell 的研究结果。他正确地得出结论，患者可能会以 BIS 值 < 60 来响应命令。他继续证明，通过故意给予不充分的麻醉，这种情况变得更有可能。我们向拉塞尔（也许还有其他麻醉深度监测怀疑论者）提出的最后一个问题是：如果他们正在使用神经肌肉阻滞的全静脉麻醉进行大手术，他们希望对自己使用什么样的监测？与麻醉师使用的所有其他监测设备一样，BIS 也有可能出现错误和人为读数。脉搏血氧饱和度并不能排除未识别的低氧血症的可能性，四组监测也不能预防术后残余血氧饱和度的发生；然而，当由受过使用培训并意识到其潜在缺陷的称职麻醉师使用它们时，这两种情况的可能性都会降低。 BIS 的目的并不是取代警惕的主治麻醉师，而是为他们提供可能使他们护理下的患者受益的额外信息。
low, and a climbing/rising BIS trace seen in Fig. 3 should be addressed immediately. The study protocol, however, involved waiting a little longer to see if the patient woke further and had a ‘hand squeezing conversation’ with the attending clinician. This, we feel, is unacceptable since, if light anaesthesia is a possibility, a cause should be sought (e.g. inadequate analgesia) and the anaesthetic adjusted accordingly, without delay. We feel that Russell should have made it clear in his discussion that accepting a BIS value > 60 is not to be encouraged unless the patient is haemodynamically stable and the anaesthetic concentrations are clinically adequate (which is questionable in this study when one example shows a propofol target concentration < 2 lg.ml ). The isolated forearm technique, if used for its original purpose and not simply to test the boundaries of probability, is undoubtedly the gold standard for monitoring wakefulness under anaesthesia; it is, however, unlikely ever to be widely adopted into routine clinical practice. As routine users of intra-operative BIS monitoring, we would urge all readers not to take the findings of Russell’s study in isolation. He has correctly concluded that patients may respond to command with a BIS value < 60. He has gone on to demonstrate that by deliberately giving an inadequate anaesthetic this becomes more likely. Our final question for Russell (and perhaps other depth of anaesthesia monitoring sceptics) is this: what kind of monitoring would they like to be used on themselves if they were undergoing major surgery using total intravenous anaesthesia with neuromuscular blockade? In common with all the other monitoring devices utilised by anaesthetists, BIS has the potential for error and artifactual readings. Pulse oximetry does not preclude the possibility of unrecognised hypoxaemia, nor can train-of-four monitoring prevent occurrences of postoperative residual curisation; the likelihood of either event is, however, diminished when they are used by a competent anaesthetist who is trained in their use and is aware of their potential flaws. BIS does not aim to replace vigilant attending anaesthetists, but rather provides them with additional information that has the potential to benefit the patients under their care.
Furukawa, K.：“在人类 T 细胞嗜淋巴细胞病毒 1 型并发的原发性免疫缺陷中，表达 γ/δ 受体和 CD4^+CD8^+ 双孔 T 细胞的数量增加。”
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