七氟醚全麻挥发性诱导时的多峰和节律性多峰导致双谱指数变化。

IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY
Michał J Stasiowski, Anna Duława, Seweryn Król, Radosław Marciniak, Wojciech Kaspera, Ewa Niewiadomska, Lech Krawczyk, Piotr Ładziński, Beniamin O Grabarek, Przemysław Jałowiecki
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引用次数: 6

摘要

背景:虽然基于脑电图(EEG)的指标可能显示人工值,但原始脑电图信号很少用于监测全身麻醉(vaga)的挥发性诱导深度。当前的分析旨在确定在全麻诱导时脑电图中存在不同类型的癫痫样模式(EPs)时,双谱指数(BIS)变化是否可靠地反映了全麻的实际深度。方法:采用七氟醚增加浓度(VIMA组)或肺活量(VCRII组)技术或单次静脉注射异丙酚(PROP组)的患者共60例。监测包括面肌电图(fEMG)、吸入七氟醚分数(FiAA)、过期七氟醚分数(FeAA)、七氟醚最小肺泡浓度(MAC)、BIS、标准EEG和血流动力学参数。结果:PROP组未见EPs。在VIMA组和VCRII组的七氟醚VIGA的不同阶段,尽管七氟醚的FiAA、FeAA和MAC没有变化,但患者脑电图中存在多峰峰和节律性多峰峰,导致假BIS值,表明麻醉后的假意识/清醒。周期性癫痫样放电不会导致BIS值异常。结论:我们的结果表明,原始脑电图与VIGA期间七氟醚的BIS、FiAA、FeAA和MAC值具有相关性。由于患者脑电图中存在多峰峰和节律性多峰峰,因此人工BIS值表明错误的意识/清醒可能会误导麻醉师,导致在通气气体中无意中使用有毒浓度的七氟醚。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Polyspikes and Rhythmic Polyspikes During Volatile Induction of General Anesthesia With Sevoflurane Result in Bispectral Index Variations.

Background: Although electroencephalography (EEG)-based indices may show artifactual values, raw EEG signal is seldom used to monitor the depth of volatile induction of general anesthesia (VIGA). The current analysis aimed to identify whether bispectral index (BIS) variations reliably reflect the actual depth of general anesthesia during presence of different types of epileptiform patterns (EPs) in EEGs during induction of general anesthesia.

Methods: Sixty patients receiving either VIGA with sevoflurane using increasing concentrations (group VIMA) or vital capacity (group VCRII) technique or intravenous single dose of propofol (group PROP) were included. Monitoring included facial electromyography (fEMG), fraction of inspired sevoflurane (FiAA), fraction of expired sevoflurane (FeAA), minimal alveolar concentration (MAC) of sevoflurane, BIS, standard EEG, and hemodynamic parameters.

Results: In the PROP group no EPs were observed. During different stages of VIGA with sevoflurane in the VIMA and VCRII groups, presence of polyspikes and rhythmic polyspikes in patients' EEGs resulted in artifactual BIS values indicating a false awareness/wakefulness from anesthesia, despite no concomitant change of FiAA, FeAA, and MAC of sevoflurane. Periodic epileptiform discharges did not result in aberrant BIS values.

Conclusion: Our results suggest that raw EEG correlate it with values of BIS, FiAA, FeAA, and MAC of sevoflurane during VIGA. It seems that because artifactual BIS values indicating false awareness/wakefulness as a result of presence of polyspikes and rhythmic polyspikes in patients' EEGs may be misleading to an anesthesiologist, leading to unintentional administration of toxic concentration of sevoflurane in ventilation gas.

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来源期刊
Clinical EEG and Neuroscience
Clinical EEG and Neuroscience 医学-临床神经学
CiteScore
5.20
自引率
5.00%
发文量
66
审稿时长
>12 weeks
期刊介绍: Clinical EEG and Neuroscience conveys clinically relevant research and development in electroencephalography and neuroscience. Original articles on any aspect of clinical neurophysiology or related work in allied fields are invited for publication.
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