Anesthesia awareness and the bispectral index
Anesthesia awareness and the bispectral index
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DOI：
10.1056/nejmoa0707361
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发表时间：
2008-03-13
影响因子：
158.5
通讯作者：
Evers, Alex S.
中科院分区：
文献类型：
--
作者：
Avidan, Michael S.;Zhang, Lini;Evers, Alex S.
背景：麻醉期间的意识是一种严重的并发症，具有潜在的长期心理后果。据报道，当 BIS 值保持在 60 以下时，使用根据处理后的脑电图开发的脑电双频指数 (BIS) 可以降低麻醉意识的发生率。在本试验中，我们试图确定基于 BIS 的方案是否优于基于呼气末麻醉气体 (ETAG) 测量的方案，以降低该并发症高风险患者的麻醉意识。方法：我们将 2000 名患者随机分配到BIS 引导麻醉（目标 BIS 范围，40 至 60）或 ETAG 引导麻醉（目标 ETAG 范围，最小肺泡浓度 0.7 至 1.3 [MAC]）。术后，以三个时间间隔（拔管后 0 至 24 小时、24 至 72 小时和 30 天）评估患者的麻醉意识。结果：我们分别评估了 BIS 组和 ETAG 组的 967 名患者和 974 名患者。每组中有 2 例出现明确的麻醉意识（绝对差异，0%；95% 置信区间 [CI]，-0.56 至 0.57%）。明确麻醉意识BIS值大于60 1例，ETAG浓度小于0.7 MAC 3例。对于所有患者，BIS 组的平均 (+/-SD) 时间平均 ETAG 浓度为 0.81+/-0.25 MAC，ETAG 组为 0.82+/-0.23 MAC（P=0.10；BIS 和 ETAG 组之间的差异为 95% CI，-0.04 至 0.01 MAC）。结论：我们没有重复之前报告的 BIS 麻醉意识发生率较低的研究结果。监测，并且 BIS 协议的使用与挥发性麻醉气体管理的减少无关。即使 BIS 值和 ETAG 浓度在目标范围内，也会出现麻醉意识。我们的研究结果不支持将常规 BIS 监测作为标准实践的一部分。 （ClinicalTrials.gov 编号，NCT00281489。）。
Background: Awareness during anesthesia is a serious complication with potential long-term psychological consequences. Use of the bispectral index (BIS), developed from a processed electroencephalogram, has been reported to decrease the incidence of anesthesia awareness when the BIS value is maintained below 60. In this trial, we sought to determine whether a BIS-based protocol is better than a protocol based on a measurement of end-tidal anesthetic gas (ETAG) for decreasing anesthesia awareness in patients at high risk for this complication.Methods: We randomly assigned 2000 patients to BIS-guided anesthesia (target BIS range, 40 to 60) or ETAG-guided anesthesia (target ETAG range, 0.7 to 1.3 minimum alveolar concentration [MAC]). Postoperatively, patients were assessed for anesthesia awareness at three intervals (0 to 24 hours, 24 to 72 hours, and 30 days after extubation).Results: We assessed 967 and 974 patients from the BIS and ETAG groups, respectively. Two cases of definite anesthesia awareness occurred in each group (absolute difference, 0%; 95% confidence interval [CI], -0.56 to 0.57%). The BIS value was greater than 60 in one case of definite anesthesia awareness, and the ETAG concentrations were less than 0.7 MAC in three cases. For all patients, the mean (+/-SD) time-averaged ETAG concentration was 0.81+/-0.25 MAC in the BIS group and 0.82+/-0.23 MAC in the ETAG group (P=0.10; 95% CI for the difference between the BIS and ETAG groups, -0.04 to 0.01 MAC).Conclusions: We did not reproduce the results of previous studies that reported a lower incidence of anesthesia awareness with BIS monitoring, and the use of the BIS protocol was not associated with reduced administration of volatile anesthetic gases. Anesthesia awareness occurred even when BIS values and ETAG concentrations were within the target ranges. Our findings do not support routine BIS monitoring as part of standard practice. (ClinicalTrials.gov number, NCT00281489.).