Study for the Correlation Among Bispectral Index and Blood Propofol Concentration with Level of Sedation in the Elderly_West China Medical Journal

Authors：

MA Youbing ¹ , WANG Hongwei ² ,  LIN Yanjun. ³

Department of Anesthesiology,West City of Bazhong,Bazhong Sichuan 635500,China; 2Department of Anesthesiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou, Henan 450000,China; 3 Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu Sichuan 610041,China;

Corresponding author：

LIN Yanjun., Email: linyanjun@163.com

Keywords：

老年人; 异丙酚; 清醒镇静; 脑电双频谱指数

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目的:探讨老年手术患者椎管内麻醉后应用异丙酚镇静,脑电双频指数、异丙酚血药浓度和镇静深度之间的相关性［1］。方法:48例ASAⅠ~Ⅱ级择期手术患者,分为老年组(65~85岁)和年轻组(18~40岁),每组24例。为尽快达到稳态血药浓度,采用靶控输注方式给药。异丙酚靶浓度从0.5 μg/mL起逐渐增加,直至患者对轻推无反应(意识消失),每个浓度维持5min。连续记录EEG参数,在每一稳态血药浓度末,记录BIS、95%SEF, 桡动脉取血(高效液相色谱法测定异丙酚血药浓度),并评定镇静深度(OAA/S评分法)。用Spearman’s等级相关进行相关分析,并计算预测概率 (Pk) 值。结果:两组BIS (r=0.935~0.955) 与镇静水平的相关性优于血药浓度(r =0.849~0.870)和95%SEF(r =0.503~0.571),BIS的Pk值高(0.942~0.972)。在同一镇静评分(OAA/S 4~1)时,老年组BIS值明显高于年轻组(P lt;0.01),而血药浓度低于年轻组(P gt;0.05)。结论:BIS在监测异丙酚镇静水平及预测意识消失方面有重要价值,在同一镇静评分时,老年人BIS值高于年轻人。

Citation： MA Youbing ,WANG Hongwei,LIN Yanjun.. Study for the Correlation Among Bispectral Index and Blood Propofol Concentration with Level of Sedation in the Elderly. West China Medical Journal, 2009, 24(8): 1991-1995. doi: Copy

1.	张德林, 庄小凤, 裘卫东, 蒋豪, 薛张纲. 脑电双频指数对镇静深度和血液动力学预测作用的研究[J]. 临床麻醉学杂志, 2004, (06): 330-332.
2.	OUATTARA A, BOCCARA G, LEMAIRE S, et al. Targetcontrolled infusion of propofol and remifentanil in cardiac anaesthesia: influence of age on predicted effectsite concentrations[J]. Br J Anaesth, 2003, 90(5): 617-22.
3.	GEPTS E. Pharmacokinetic concepts for TCI anaesthesia[J]. Anaesthesia, 1998, 53 Suppl 1: 4-12.
4.	PUNJASAWADWONG Y, BOONJEUNGMONKOL N, PHONGCHIEWBOON A. Bispectral index for improving anaesthetic delivery and postoperative recovery[J]. Cochrane Database Syst Rev, 2007, (4): CD003843.
5.	GLASS P S, BLOOM M, KEARSE L, et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers[J]. Anesthesiology, 1997, 86(4): 836-847.
6.	PUNJASAWADWONG Y, BOONJEUNGMONKOL N, PHONGCHIEWBOON A. Bispectral index for improving anaesthetic delivery and postoperative recovery[J]. Cochrane Database Syst Rev, 2007, (4): CD003843.
7.	KAZAMA T, IKEDA K, MORITA K, et al. Comparison of the effectsite k(eO)s of propofol for blood pressure and EEG bispectral index in elderly and younger patients[J]. Anesthesiology, 1999, 90(6): 1517-1527.
8.	MARCIANI R D. Critical systemic and psychosocial considerations in management of trauma in the elderly[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1999, 87(3): 272-280.
9.	SEVERN A. Anaesthesia and the preparation and management of elderly patients undergoing surgery[J]. Eur J Cancer, 2007, 43(15): 2231-2234.
10.	KEARSE LA J R, ROSOW C, ZASLAVSKY A, et al. Bispectral analysis of the electroencephalogram predicts conscious processing of information during propofol sedation and hypnosis[J]. Anesthesiology, 1998, 88(1): 25-34.
11.	BANNISTER C F, BROSIUS K K, SIGL J C, et al. The effect of bispectral index monitoring on anesthetic use and recovery in children anesthetized with sevoflurane in nitrous oxide[J]. Anesth Analg, 2001, 92(4): 877-881.
12.	MONARCH S, WREN K. Geriatric anesthesia implications[J]. J Perianesth Nurs, 2004, 19(6): 379-384.
13.	PAUL S D, O’GARA P T, MAHJOUB Z A, et al. Geriatric patients with acute myocardial infarction: Cardiac risk factor profiles, presentation, thrombolysis, coronary interventions, and prognosis[J]. Am Heart J, 1996, 131(4): 710-715.
14.	AGARWAL A, PANDEY R, DHIRAAJ S, et al. The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium[J]. Anesth Analg, 2004, 99(6): 1684-1688.

1. 张德林, 庄小凤, 裘卫东, 蒋豪, 薛张纲. 脑电双频指数对镇静深度和血液动力学预测作用的研究[J]. 临床麻醉学杂志, 2004, (06): 330-332.
2. OUATTARA A, BOCCARA G, LEMAIRE S, et al. Targetcontrolled infusion of propofol and remifentanil in cardiac anaesthesia: influence of age on predicted effectsite concentrations[J]. Br J Anaesth, 2003, 90(5): 617-22.
3. GEPTS E. Pharmacokinetic concepts for TCI anaesthesia[J]. Anaesthesia, 1998, 53 Suppl 1: 4-12.
4. PUNJASAWADWONG Y, BOONJEUNGMONKOL N, PHONGCHIEWBOON A. Bispectral index for improving anaesthetic delivery and postoperative recovery[J]. Cochrane Database Syst Rev, 2007, (4): CD003843.
5. GLASS P S, BLOOM M, KEARSE L, et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers[J]. Anesthesiology, 1997, 86(4): 836-847.
6. PUNJASAWADWONG Y, BOONJEUNGMONKOL N, PHONGCHIEWBOON A. Bispectral index for improving anaesthetic delivery and postoperative recovery[J]. Cochrane Database Syst Rev, 2007, (4): CD003843.
7. KAZAMA T, IKEDA K, MORITA K, et al. Comparison of the effectsite k(eO)s of propofol for blood pressure and EEG bispectral index in elderly and younger patients[J]. Anesthesiology, 1999, 90(6): 1517-1527.
8. MARCIANI R D. Critical systemic and psychosocial considerations in management of trauma in the elderly[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1999, 87(3): 272-280.
9. SEVERN A. Anaesthesia and the preparation and management of elderly patients undergoing surgery[J]. Eur J Cancer, 2007, 43(15): 2231-2234.
10. KEARSE LA J R, ROSOW C, ZASLAVSKY A, et al. Bispectral analysis of the electroencephalogram predicts conscious processing of information during propofol sedation and hypnosis[J]. Anesthesiology, 1998, 88(1): 25-34.
11. BANNISTER C F, BROSIUS K K, SIGL J C, et al. The effect of bispectral index monitoring on anesthetic use and recovery in children anesthetized with sevoflurane in nitrous oxide[J]. Anesth Analg, 2001, 92(4): 877-881.
12. MONARCH S, WREN K. Geriatric anesthesia implications[J]. J Perianesth Nurs, 2004, 19(6): 379-384.
13. PAUL S D, O’GARA P T, MAHJOUB Z A, et al. Geriatric patients with acute myocardial infarction: Cardiac risk factor profiles, presentation, thrombolysis, coronary interventions, and prognosis[J]. Am Heart J, 1996, 131(4): 710-715.
14. AGARWAL A, PANDEY R, DHIRAAJ S, et al. The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium[J]. Anesth Analg, 2004, 99(6): 1684-1688.

West China Medical Journal

Study for the Correlation Among Bispectral Index and Blood Propofol Concentration with Level of Sedation in the Elderly

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