Effects of lidocaine bolus and infusion on neuromonitoring by bispectral index (BIS®), electroencephalogram periodic and aperiodic activity, and Surgical Pleth Index® during propofol-remifentanil anaesthesia: a single-centre prospective observational study.

IF 10.3 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2026-11-01 Epub Date: 2026-09-23 DOI:10.1016/j.bja.2026.07.058

Federico Linassi, Michele Carron, Paolo Zanatta, Duygu Aydin, Leonardo Spano, Christian Rizzetto, Luigi Polesello, Gerhard Schneider, Vincent Bonhomme, Matthias Kreuzer

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引用次数: 0

Abstract

Background: Lidocaine administration during stable propofol-remifentanil anaesthesia causes a decrease in bispectral index (BIS®), although its influence on hypnosis is debated. We evaluated dose-dependent lidocaine effects on spectral EEG features and the processed parameters BIS and 95% spectral edge frequency (SEF₉₅).

Methods: We conducted an observational, prospective, single-centre study analysing intraoperative data from 20 adult female patients undergoing breast surgery. During stable propofol-remifentanil target-controlled infusion, we delivered an i.v. lidocaine bolus (1.5 mg kg^-1) over 10 min, followed by a 30 min infusion at a rate of 1.5 mg kg^-1 h^-1. We evaluated the lidocaine-induced change in EEG spectral composition, including aperiodic and periodic features, BIS, SEF₉₅, and Surgical Pleth Index® (SPI).

Results: We observed an increase in delta-band EEG activity and a decrease in beta-band EEG activity 4 to 6 min after the bolus, whereas BIS and SEF₉₅ did not change significantly. The alpha peak features bandwidth and centre frequency also decreased significantly in the early period. The aperiodic slope slightly but significantly increased after the bolus and during infusion. During the infusion phase, BIS and SEF₉₅ significantly decreased after 12 to 15 min, as did SPI in the later stages of the infusion phase.

Conclusions: When lidocaine is given during stable propofol-remifentanil anaesthesia, changes in spectral EEG parameters occur earlier than changes in BIS, SEF₉₅ and SPI. The observed EEG and SPI changes are consistent with a predominant antinociceptive contribution to the anaesthetic-sparing effects of lidocaine, although the physiological interpretation of the derived parameters remains an evolving area of research.

Clinical trial registration: NCT06135688.

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异丙酚-瑞芬太尼麻醉期间，利多卡因单中心和输注对双谱指数（BIS®）、脑电图周期性和非周期性活动以及手术体积指数®神经监测的影响：一项单中心前瞻性观察研究。

背景：在稳定异丙酚-瑞芬太尼麻醉期间给予利多卡因可导致双谱指数（BIS®）下降，尽管其对催眠的影响尚存在争议。我们评估了剂量依赖性利多卡因对脑电图特征和处理参数BIS和95%谱边缘频率（SEF95）的影响。方法：我们进行了一项观察性、前瞻性、单中心研究，分析了20例接受乳房手术的成年女性患者的术中数据。在稳定的异丙酚-瑞芬太尼靶控输注过程中，我们在10分钟内静脉注射利多卡因（1.5 mg kg-1），然后以1.5 mg kg-1 h-1的速度输注30分钟。我们评估了利多卡因引起的脑电图谱组成的变化，包括非周期和周期特征、BIS、SEF95和外科容积指数®（SPI）。结果：我们观察到在给药后4 ~ 6 min， delta-band EEG活动增加，β -band EEG活动减少，而BIS和SEF95无明显变化。α峰特征带宽和中心频率在早期也明显下降。非周期斜率在给药后和给药过程中略有但显著增加。在输注阶段，BIS和SEF95在12 ~ 15 min后显著下降，SPI在输注阶段后期也显著下降。结论：在异丙酚-瑞芬太尼稳定麻醉期间给予利多卡因时，脑电图谱参数的变化早于BIS、SEF95和SPI的变化。观察到的脑电图和SPI变化与利多卡因对麻醉保留作用的主要抗感觉作用一致，尽管衍生参数的生理学解释仍然是一个不断发展的研究领域。临床试验注册：NCT06135688。

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.