Effects of isoflurane and propofol on cortical somatosensory evoked potentials during comparable depth of anaesthesia as guided by bispectral index
Effects of isoflurane and propofol on cortical somatosensory evoked potentials during comparable depth of anaesthesia as guided by bispectral index
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DOI：
10.1093/bja/aei003
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发表时间：
2005-02-01
影响因子：
9.8
通讯作者：
Lee, TL
中科院分区：
文献类型：
--
作者：
Liu, EHC;Wong, HK;Lee, TL
背景资料。本研究的目的是以脑电双频指数(BIS)为指标，比较异丙酚和异氟醚在相同麻醉深度下对脊柱手术中皮层体感诱发电位(SSEP)的抑制程度。这是一项异丙酚和异氟醚的随机对照试验，涉及60名接受择期脊柱手术的患者。使用BIS监测来指导一致和可比较的麻醉深度，麻醉期间指数维持在40~50之间。在麻醉诱导前、麻醉诱导后、皮肤切开开始、椎弓根螺钉置入开始和置棒开始时，由一位药物盲人的神经生理学家测量皮层SSEP P40-N50的峰间波幅和达到P40峰的潜伏期。异丙酚和异氟醚均使麻醉过程中SSEP波幅降低，潜伏期延长。在达到相同的麻醉深度后，异氟醚的SSEP波幅明显降低，分别为1.5mV和2.4mV(P=0.005)。异氟醚组潜伏期明显延长，分别为39.5(3.9ms)和37.3ms(3.1ms)(P=0.024)。异氟醚与麻醉过程和手术过程中体感诱发电位波幅的变异较大，变异系数分别为35.4vs21.2(10.2)%(P=0.008)。异丙酚麻醉对皮层SSEP的抑制较小，SSEP波幅保存较好，在相同麻醉深度时变异性较小。
Background. The aim of this study was to determine if propofol caused less suppression of cortical somatosensory evoked potentials (SSEPs) during spine surgery compared with isoflurane during comparable depth of anaesthesia as guided by bispectral index (BIS) measurements.Methods. This was a randomized controlled trial of propofol and isoflurane involving 60 patients undergoing elective spine surgery. BIS monitoring was used to guide a consistent and comparable depth of anaesthesia, the index was maintained at between 40 and 50 during anaesthesia. The cortical SSEP P40-N50 peak-to-peak amplitude and latency time to the P40 peak were measured before induction of anaesthesia, after induction of anaesthesia, at the start of skin incision, at the start of pedicle screw insertion and at the start of rod insertion, by a neurophysiologist blinded to drug allocation.Results. Both propofol and isoflurane decreased SSEP amplitude and increased latency during the course of anaesthesia. After achieving a comparable depth of anaesthesia, the SSEP amplitude was significantly lower with isoflurane, 1.5 (1.0) vs 2.4 (1.4) muV (P=0.005). Latency was significantly longer with isoflurane, 39.5 (3.9) vs 37.3 (3.1) ms (P=0.024). Isoflurane was associated with greater variability of SSEP amplitude during the course of anaesthesia and surgery, coefficient of variation 35.4 (18.0) vs 21.2 (10.2)% (P=0.008).Conclusions. Propofol anaesthesia caused less suppression of the cortical SSEP, with better preservation of SSEP amplitude, and less variability at an equivalent depth of anaesthesia.