Liver transplantation (LT) recipients are known to require less anesthetic agents. Providing minimally required anesthetics while avoiding awareness is especially important in LT recipients because it would help manag...Liver transplantation (LT) recipients are known to require less anesthetic agents. Providing minimally required anesthetics while avoiding awareness is especially important in LT recipients because it would help manage perioperative hemodynamic instability with less vasopressor and fast track recovery. This study aims to compare state entropy (SE) against bispectral index (BIS) during isoflurane anesthesia in LT. We adjusted anesthesia to BIS values 40 - 60, and compared it with concomitant SE values. BIS, SE values, and anesthetic requirements according to liver failure severity, etiology and LT stages were analyzed. For BIS-SE differences, SE value that is different from the concomitant BIS by more than 15 was defined as a significant disagreement. Mann Whitney, Kruskal Wallis test and a Poisson exact test were used for analysis. The BIS-SE pair sets of 2895 from 38 patients were analyzed. BIS, SE values and anesthetic requirements were significantly lower in MELD ≥ 20 (p < 0.001 in all) and in alcoholic etiology (p < 0.001 in all). For BIS-SE differences, 320 disagreement data pairs were seen at a rate of 1.33 times/hr (95% CI = [1.19, 1.48], p < 0.001). A significant disagreement was delineated in MELD score ≥ 20 (3.04 times/hr, CI = [2.64, 3.49], p < 0.001), alcoholic etiology (3.19 times/hr, [2.67, 3.78], p < 0.001) and postreperfusion stage (1.63 times/hr, [1.43, 1.85], p < 0.001). In these significant BIS-SE differences, 95.9% (307/320 disagreement data pairs) showed higher BIS than SE. In conclusion, in high MELD and alcoholic etiology, anesthetic requirements were significantly less, and BIS and SE showed great discrepancy with lower SE values. Therefore, when SE monitoring is used during LT, anesthesiologists may need to consider that in high MELD and alcoholic etiology, SE tends to show lower values than the concomitant BIS values that are within optimal anesthetic depth ranges.展开更多
文摘目的探讨使用听觉诱发电位指数（A-line ARX-index，AAI）、BIS监测麻醉深度对老年患者全身麻醉下行全膝关节置换术术中麻醉药用量及术后恢复的影响。方法择期全身麻醉下行全膝关节置换术的老年患者60例，年龄65。75岁，体重45-85kg，ASA分级Ⅰ、Ⅱ级，采用随机数字表法将患者分为3组（每组20例）：使用AAI监测麻醉深度组（AAI组）、使用BIS监测麻醉深度组（BIS组）和5年以上经验麻醉医师调控麻醉深度组（CON组）。于术前1d和术后1、3、5、7d行简明精神状态量表（mini-mental state examination, MMSE ）评分，以此评估患者认知功能；记录3组患者的全身麻醉药物用量，术毕时患者的苏醒时间、拔管时间、警觉镇静（observer assessment of sedation, OAA/S）评分和VAS评分。结果AAI组和BIS组的丙泊酚用量[（450±19）、（500±18）mg]及瑞芬太尼用量[（0．78±0．07）、（0．80±0．08）mg]比CON组[丙泊酚（810±17）mg、瑞芬太尼（1．26±0．07）mg]少（P〈0．05），AAI组的丙泊酚用量比BIS组更少，差异有统计学意义（P〈0．05）；术毕AAI组和BIS组的苏醒时间[（5．4±1．5）、（10．2±1.3）min]和拔管时间[（7．3±1．6）、（14．5±1．5）min]比CON组[苏醒时间（15．3±1．8）min、拔管时间（18．2±1．7）min]短（P〈0．05），与CON组相比，AAI组和BIS组OAA／S评分高[AAI组（4．45±0．35）分、BIS组（3．74±0．43）分、CON组（2．85±0．24）分]（P〈0．05）；3组患者VAS评分[AAI组（2．0±0.6）分、BIS组（2．1±0．5）分、CON组（2．3±0．7）分]差异无统计学意义（P〉0．05）；3组术前1d，术后1、3、5、7d时MMSE评分比较，差异无统计学意义（P〉0.05）。结论应用麻醉深度监测可以节俭麻醉药用量，缩短苏醒和拔管时间，但是对MMSE评分没有明显影响。
文摘Liver transplantation (LT) recipients are known to require less anesthetic agents. Providing minimally required anesthetics while avoiding awareness is especially important in LT recipients because it would help manage perioperative hemodynamic instability with less vasopressor and fast track recovery. This study aims to compare state entropy (SE) against bispectral index (BIS) during isoflurane anesthesia in LT. We adjusted anesthesia to BIS values 40 - 60, and compared it with concomitant SE values. BIS, SE values, and anesthetic requirements according to liver failure severity, etiology and LT stages were analyzed. For BIS-SE differences, SE value that is different from the concomitant BIS by more than 15 was defined as a significant disagreement. Mann Whitney, Kruskal Wallis test and a Poisson exact test were used for analysis. The BIS-SE pair sets of 2895 from 38 patients were analyzed. BIS, SE values and anesthetic requirements were significantly lower in MELD ≥ 20 (p < 0.001 in all) and in alcoholic etiology (p < 0.001 in all). For BIS-SE differences, 320 disagreement data pairs were seen at a rate of 1.33 times/hr (95% CI = [1.19, 1.48], p < 0.001). A significant disagreement was delineated in MELD score ≥ 20 (3.04 times/hr, CI = [2.64, 3.49], p < 0.001), alcoholic etiology (3.19 times/hr, [2.67, 3.78], p < 0.001) and postreperfusion stage (1.63 times/hr, [1.43, 1.85], p < 0.001). In these significant BIS-SE differences, 95.9% (307/320 disagreement data pairs) showed higher BIS than SE. In conclusion, in high MELD and alcoholic etiology, anesthetic requirements were significantly less, and BIS and SE showed great discrepancy with lower SE values. Therefore, when SE monitoring is used during LT, anesthesiologists may need to consider that in high MELD and alcoholic etiology, SE tends to show lower values than the concomitant BIS values that are within optimal anesthetic depth ranges.
