癫痫手术大脑皮层脑电图监测期间麻醉深度变化与术中知晓的临床观察

Intraoperative awareness in epileptic patients during the period of Cerebral cortex electroencephalography measurement under general anesthesia

目的观察不需术中唤醒的癫痫病人术中知晓的发生,探讨此类病人的麻醉方案,提高麻醉和手术的满意度。方法 25例需手术治疗的癫痫病人,气管内插管全麻,丙泊酚及瑞芬太尼靶控输注麻醉诱导及维持,右美托咪定持续输注,脑电双频指数(BIS)维持在40±5。在大脑皮层脑电图(ECoG)监测期间,调整麻醉药物剂量,观察并记录BIS在<40,40～50,50～60,60～70,及>70期间脑电变化。ECoG监测结束后静脉注射咪达唑伦0.05 mg/kg,调整丙泊酚及瑞芬太尼剂量,使BIS值回复至40±5至术终。术后第1,3,7天对患者问卷调查,评价术中知晓的发生。结果 25例病人麻醉效果良好。术中知晓发生率为8%(2/25)。80%(20/25)的病例对麻醉满意或比较满意。结论对术中知晓的高危病人,应用丙泊酚、瑞芬太尼及右美托咪定持续输注,辅以苯二氮卓类药物、术中BIS监测、可能减少术中知晓的发生,保证病人对麻醉的满意度。

Objective To investigate the incidence of intraoperative awareness in epileptic patients during the period of cerebral cortex electroencephalography （ECoG） measurement under general anesthesia. Methods Twenty five patients un- dergoing epileptic loci resection or electrode implantation procedures under anesthesia were enrolled in the study. Target controlled infusion （TCI） of remifentanil and propofol were applied for the induction of anesthesia. The maintenance of an- esthesia was achieved using TCI technique of remifentanil and propofol as well as continuous infusion of dexmedetomidine to maintain the BIS value at the range of 40 ＋ 5. During the period of cerebral cortex EEG （ECoG） measurement, the infusion rates of remifentanil, propofol and dexmedetomidine were reduced in order to obtain the BIS value at the following ranges： 〈40, 40 - 50, 50 - 60, 60 - 70, and 〉 70. The duration of the period at each range was sustained for 5 minutes. When the cerebral cortex EEG （ECoG） measurement was accomplished, midazolam 0.05 mg/kg was administered intravenously and the initial infusion rates of remifentanil, propofol and dexmedetomidine were resumed to produce the BIS values to the range of 40 ± 5 until the end of the surgical procedures. Questionnaires were obtained from the patients to assess the inci- dence of intraoperative awareness at the first, 3rd and 7th days after operation. Results The surgical procedures were com- pleted uneventfully under the present regimen of general anesthesia. Intraoperative awareness occurred in 2 out of 25 cases. Although the rate of intraoperative awareness was 8% , 80% of the patients were satisfied with the anesthesia regimn. Con- clusions In patients with high risk of intraoperative awareness, the missionary details should be informed to the patients pri- or to the surgery. An appropriate anesthestic regimes and BIS monitoring are necessary components to reduce the incidence of intraoperative awareness in the epileptic patients undergoing Cerebral cortex electroencephalography （ECoG） measure- ment during surgical procedure under general anesthesia.