Ingestion of stimulant medications does not alter bispectral index or clinical depth of anesthesia at 1 MAC sevoflurane in children
Ingestion of stimulant medications does not alter bispectral index or clinical depth of anesthesia at 1 MAC sevoflurane in children
复制标题
DOI：
10.1111/j.1460-9592.2011.03717.x
复制
发表时间：
2012-04-01
影响因子：
1.7
通讯作者：
Forsyth, Ian
中科院分区：
文献类型：
--
作者：
Chambers, Neil A.;Pascoe, Elaine;Forsyth, Ian
背景/目的：使用兴奋剂药物治疗注意缺陷多动障碍（ADHD）行为管理的儿童可能需要择期手术。刺激性药物治疗通常持续到手术当天早上，以优化围手术期行为。目前还不清楚这种兴奋剂药物摄入是否会影响大脑唤醒和改变麻醉深度。一个临床相关的改变，在测量的麻醉深度可以形成一个循证的建议，儿童服用兴奋剂药物需要改变的麻醉剂的量，或他们需要常规监测的麻醉深度。材料和方法：34阿萨1和2的儿童年龄在5至16岁之间，提出择期手术，被招募的基础。17人被诊断为ADHD，并在手术当天服用了兴奋剂药物，17人是对照组。通过面罩使用空气、氧气和七氟烷进行标准吸入麻醉诱导，并在1 MAC呼气末七氟烷下维持10 min。在此期间，没有对患者施加其他刺激。10 min后记录脑电双频指数（BIS）和其他麻醉深度指标。结果：两组患儿年龄和体重相似。在兴奋剂组中，男孩的比例较高。两组的基线生理参数相似。在1 MAC endtidal七氟烷麻醉诱导和平衡10分钟后，BIS或麻醉深度的临床标志物没有显着差异。结论：儿童服用兴奋剂药物治疗ADHD，谁摄入药物的手术当天，似乎没有改变BIS或麻醉深度在1 MAC的七氟烷。这些结果不支持手术当天摄入兴奋剂的儿童的麻醉实践改变的建议，无论是增加麻醉剂量还是监测深度。
Background/Aim: Children treated with stimulant medications for the behavioral management of attention deficit hyperactivity disorder (ADHD) may present for elective surgery. Stimulant medication is often continued until the morning of surgery to optimize perioperative behavior. It is unknown whether such stimulant drug ingestion can affect cerebral arousal and alter depth of anesthesia. A clinically relevant alteration in measured depth of anesthesia could form the basis for an evidence-based recommendation that children taking stimulant medications require a change in the amount of anesthetic delivered or that they require routine monitoring of depth of anesthesia.Materials and Methods: Thirty-four ASA 1 and 2 children aged between 5 and 16, presenting for elective day case surgery, were recruited. Seventeen had a diagnosis of ADHD and had taken stimulant medication on the day of surgery, and 17 were controls. A standard inhalational induction of anesthesia using air, oxygen, and sevoflurane by facemask was performed and maintained for 10 min at 1 MAC endtidal sevoflurane. During this time, no other stimulus was applied to the patient. Bispectral index (BIS) and other markers of depth of anesthesia were recorded after 10 min.Results: Children in both groups were of similar ages and weights. There were a higher percentage of boys in the stimulants group. Baseline physiological parameters were similar in both groups. After induction and equilibration for 10 min of anesthesia at 1 MAC endtidal sevoflurane, there was no significant difference in BIS or clinical markers of depth of anesthesia.Conclusions: Children taking stimulant medication for ADHD, and who ingest medication on the day of surgery, do not appear to have altered BIS or depth of anesthesia at 1 MAC of sevoflurane. These results do not support a recommendation for a change in anesthetic practice for children having ingested stimulants up to the day of surgery, either in terms of increasing the amount of anesthetic given or monitoring of depth.