BIS-guided Anesthesia Decreases Postoperative Delirium and Cognitive Decline
BIS-guided Anesthesia Decreases Postoperative Delirium and Cognitive Decline
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DOI：
10.1097/ana.0b013e3182712fba
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发表时间：
2013-01-01
影响因子：
3.7
通讯作者：
Gin, Tony
中科院分区：
文献类型：
--
作者：
Chan, Matthew T. V.;Cheng, Benny C. P.;Gin, Tony
背景：以往的临床试验和动物实验表明，全身麻醉剂的长期神经毒性可能导致术后认知功能障碍（POCD）。脑功能监测，如双谱指数（BIS）有助于麻醉滴定，并已被证明可以减少麻醉暴露。在一项随机对照试验中，我们检测了921例接受重大非心脏手术的老年患者BIS监测对POCD的影响。方法：患者随机分配接受bis引导麻醉或常规护理。BIS组在麻醉维持期间调整麻醉使BIS值维持在40 - 60之间。常规护理组测量BIS，但未向主治麻醉师透露。根据传统临床体征和血流动力学参数调整麻醉。手术前、术后1周和3个月分别进行神经心理学测试。结果与同期未做手术的对照患者进行比较。谵妄以神志不清评定法标准测定。结果：对照组麻醉维持期BIS值中位数（四分位差）为36(31 ~ 49)，显著低于BIS引导组的53 (48 ~ 57),P < 0.001。bis引导麻醉使异丙酚的输送减少21%，挥发性麻醉剂的输送减少30%。BIS组谵妄患者较少（15.6% vs. 24.1%, P = 0.01）。尽管两组患者在术后1周的认知表现相似，但BIS组患者在术后3个月的POCD发生率较常规护理低（10.2% vs. 14.7%；调整优势比0.67；95%可信区间，0.32-0.98;P = 0.025）。结论：bis引导麻醉减少了术后3个月的麻醉暴露，降低了POCD的风险。对于每1000名接受大手术的老年患者，将麻醉剂量调整到BIS值在40到60之间，可以防止23名患者出现POCD， 83名患者出现谵妄。
Background: Previous clinical trials and animal experiments have suggested that long-lasting neurotoxicity of general anesthetics may lead to postoperative cognitive dysfunction (POCD). Brain function monitoring such as the bispectral index (BIS) facilitates anesthetic titration and has been shown to reduce anesthetic exposure. In a randomized controlled trial, we tested the effect of BIS monitoring on POCD in 921 elderly patients undergoing major noncardiac surgery.Methods: Patients were randomly assigned to receive either BIS-guided anesthesia or routine care. The BIS group had anesthesia adjusted to maintain a BIS value between 40 and 60 during maintenance of anesthesia. Routine care group had BIS measured but not revealed to attending anesthesiologists. Anesthesia was adjusted according to traditional clinical signs and hemodynamic parameters. A neuropsychology battery of tests was administered before and at 1 week and 3 months after surgery.Results were compared with matched control patients who did not have surgery during the same period. Delirium was measured using the confusion assessment method criteria. Results: The median (interquartile range) BIS values during the maintenance period of anesthesia were significantly lower in the control group, 36 (31 to 49), compared with the BIS-guided group, 53 (48 to 57), P < 0.001. BIS-guided anesthesia reduced propofol delivery by 21% and that for volatile anesthetics by 30%. There were fewer patients with delirium in the BIS group compared with routine care (15.6% vs. 24.1%, P = 0.01). Although cognitive performance was similar between groups at 1 week after surgery, patients in the BIS group had a lower rate of POCD at 3 months compared with routine care (10.2% vs. 14.7%; adjusted odds ratio 0.67; 95% confidence interval, 0.32-0.98; P = 0.025).Conclusions: BIS-guided anesthesia reduced anesthetic exposure and decreased the risk of POCD at 3 months after surgery. For every 1000 elderly patients undergoing major surgery, anesthetic delivery titrated to a range of BIS between 40 and 60 would prevent 23 patients from POCD and 83 patients from delirium.