The significant contribution of the partitioning effect in lipid resuscitation for bupivacaine-induced cardiotoxicity: evaluation using centrifuged solution in vivo and in isolated hearts
The significant contribution of the partitioning effect in lipid resuscitation for bupivacaine-induced cardiotoxicity: evaluation using centrifuged solution in vivo and in isolated hearts
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脂质复苏中分配效应对布比卡因诱导的心脏毒性的显着贡献：使用体内和离体心脏中的离心溶液进行评估
DOI：
10.1093/bja/aev385
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发表时间：
2015
影响因子：
9.8
通讯作者：
Kiyonobu Nishikawa
中科院分区：
文献类型：
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作者：
Kotaro Hori;Tadashi Matsuura;Shogo Tsujikawa;Takashi Mori;Miyuki Kuno;Kiyonobu Nishikawa
M-Entropy（GE Healthcare，Finland）通过状态熵（SE）和响应熵（RE）这两个参数指示DOA。SE是在反映催眠成分的频谱（0.8-32 Hz）的EEG主导部分上计算的。RE涵盖频谱的EEG和肌电图（EMG）分量（0.8-47 Hz）。1，是两个参数中反应较快的。由于EMG干扰而增加的RE值并不罕见，但理论上SE值不应随着EMG干扰而增加，因为频谱仅反映EEG分量。RE-SE差异已被广泛报道为面部EMG激活或抗伤害感受的有用指标。2-4我们报告了在七氟烷/罗库溴铵麻醉下，观察到RE和SE均大幅增加至清醒值，随着罗库溴铵剂量的增加，RE和SE完全恢复至深度麻醉值。一位71岁的男性（阿萨II级）患有胰头癌，在我们的机构接受了维普莱手术。麻醉诱导用咪唑安定、芬太尼和丙泊酚。罗库溴铵促进气管插管。使用七氟烷/芬太尼/罗库溴铵维持麻醉，目标七氟烷呼气末浓度为1.4。监测连续ECG、体积描记术、有创血压、潮气末二氧化碳和药物浓度。使用M-熵模块（GE Healthcare，Finland）监测DOA，使用NMT模块（GE Health Care，Finland）监测肌肉松弛。在手术过程中，我们注意到RE和SE（图1）突然大幅增加至清醒值（分别为97和85）。无自主神经体征表明麻醉深度或镇痛不足，心率和血压保持稳定。瞳孔较小，居中。NMT监测器显示四个成串（TOF）计数为4。增加罗库溴铵剂量后，RE和SE值立即下降至< 40（图2）。在案件中，这种情况重复了好几次。患者报告术后无意识。虽然RE的增加可能是EMG干扰的结果，但SE的增加通常被认为是由于意识水平的增加。当然，SE和RE的突然增加表明意识向清醒状态的增加，除非证明不是这样。我们的案例表明，
M-Entropy (GE Healthcare, Finland) indicates DOA through two parameters, State Entropy (SE) and Response Entropy (RE). SE is computed over the EEG dominant part of the frequency spectrum (0.8–32 Hz) reflecting the hypnotic component. RE covers both the EEG and electromyogram (EMG) component of the spectrum (0.8–47 Hz). 1 and is the faster reacting of the two parameters. Increased RE values from EMG interference are not uncommon, but theoretically SE values should not increase with EMG interference as the frequency spectrum reflects solely the EEG component. RE-SE difference has been variably reported to be a useful indicator of facial EMG activation or antinociception. 2–4 We report our observation of large increases in both RE and SE to awake values under sevoflurane/rocuronium anaesthesia, with complete return to deep anaesthesia values with administration of an incremental rocuronium dose. A 71 yr old male (ASA status II) with carcinoma of the head of the pancreas underwent a Whipple’s procedure in our institution. Anaesthesia was induced with midazolam, fentanyl and propofol. Tracheal intubation was facilitated with rocuronium. Anaesthesia was maintained with sevoflurane/fentanyl/rocuronium, with target end-tidal sevoflurane of 1.4. Continuous ECG, plethysmography, invasive bp, end-tidal carbon dioxide and agent concentrations were monitored. DOA was monitored with an M-Entropy module (GE Healthcare, Finland) and muscle relaxation was monitored with an NMT module (GE Health Care, Finland). During the procedure we noted a sudden large increase in RE and SE (Fig. 1) to awake values (97 and 85 respectively). There were no autonomic signs of inadequate depth of anaesthesia or analgesia with heart rate and bp remaining stable. Pupils were small and central. The NMT monitor showed a train-of-four (TOF) count of four. An incremental dose of rocuronium was administered and both RE and SE values decreased immediately to< 40 (Fig. 2). This exact scenario was repeated several times during the case. The patient reported no awareness postoperatively. While an increase in RE can be as a result of EMG interference, an increase in SE is universally considered to be because of an increase in level of consciousness. Certainly a sudden increase in both SE and RE indicates an increase in consciousness towards the awake state until proved otherwise. Our case illustrates that this