Carotid angioplasty and stenting (CAS) was developed to be a less invasive and complex procedure compared to carotid endarterectomy (CEA). It has emerged as an alternative for patients who are considered to have high ...Carotid angioplasty and stenting (CAS) was developed to be a less invasive and complex procedure compared to carotid endarterectomy (CEA). It has emerged as an alternative for patients who are considered to have high surgical risks due to medical comorbidities or anatomical high-risk features [1]. The procedure is usually done under local anesthesia with light sedation, with the subsequent expectation of less neurologic injury, venous thromboembolisms, and myocardial infarctions—all well-known clinical risks of undergoing surgical procedures under general anesthesia. CAS, however, carries some increased risks of arterial dissection, dislocation of atherothrombotic debris and embolization to the brain or eye, late embolization due to thrombus formation on the damaged plaque, and bradycardia and hypotension as a result of carotid sinus stimulation. Electroencephalography can detect cerebral ischemia and hypoxia along with measuring hypnotic effects, but has not been reported to be used during CAS to signal impending neurological deficit and allow for intervention to prevent stroke. We report on the use of patient state index (PSI), an electroencephalographic (EEG) derived variable used by SEDLine monitor (Masimo Inc., San Diego, CA) to monitor changes in cerebral blood flow during carotid angioplasty and stenting in an awake patient under local anesthesia. PSI was developed to measure the level of hypnosis and sedation during anesthesia and in the ICU. The PSI is based on quantitative electroencephalogram features, recorded from anterior and posterior scalp sites, as input to a multivariate algorithm that quantifies the most probable level of anesthesia or sedation. The PSI is reported as a range from 0 to 100, with decreasing values indicating increasing levels of anesthesia or sedation. Adequate depth of anesthesia is reflected by PSI value of 25 - 50, and a fully awake state by a PSI of 100 [2]. Other EEG analysis techniques have been explored to detect changes in cerebral blood flow during carotid surgery [3], such as entropy described by Khan and Ozcan in his recent work entitled Disagreement in Bilateral State Entropy Values in Carotid Artery Disease [4], but there are no previous reports of the use of PSI during procedural sedation in carotid angioplasty and stenting in an awake patient.展开更多
目的:研究麻醉深度指数(Cerebral state inder,CSI)反馈调控老年肿瘤患者靶控输注(Target controlled infusion,TCI)丙泊酚的效果。方法:胃癌及直肠癌根治术126例,年龄≥65岁,ASAⅠ～Ⅱ级,随机分为反馈靶控组和靶控组,每组各63例。反馈...目的:研究麻醉深度指数(Cerebral state inder,CSI)反馈调控老年肿瘤患者靶控输注(Target controlled infusion,TCI)丙泊酚的效果。方法:胃癌及直肠癌根治术126例,年龄≥65岁,ASAⅠ～Ⅱ级,随机分为反馈靶控组和靶控组,每组各63例。反馈组设定CSI=50,两组丙泊酚的血浆靶浓度设定为2μg/ml,舒芬太尼的血浆靶浓度麻醉诱导时1.5ng/ml,麻醉维持时0.3ng/ml。记录基础值(T1)、插管(T2)、插管后5min(T3)、切皮(T4)、肿瘤切除(T5)和手术结束(T6)等时点的MAP、HR、HRV和CSI值的变化,统计丙泊酚的用量。结果:靶控组在插管后5min(T3)、切皮(T4)、切肿瘤(T5)等时点的MAP下降比反馈靶控组明显(P<0.05);HRV在插管后5min(T3)、肿瘤切除(T5)时下降较反馈靶控组明显(P<0.05);反馈靶控组的CSI值波动小于靶控组(P<0.05),丙泊酚的用量也小于靶控组(P<0.05)。结论:麻醉深度指数反馈调控靶控输注丙泊酚对老年肿瘤患者的麻醉安全可行。展开更多
目的:探讨脑状态指数(cerebral state index,CSI)指导下异丙酚复合瑞芬太尼全麻对腹部手术老年患者麻醉恢复和全麻药物用量的影响。方法:腹部择期手术65岁以上患者40例,随机分为A组(CSI组)和B组(对照组),每组20例,A组通过调控异丙酚复...目的:探讨脑状态指数(cerebral state index,CSI)指导下异丙酚复合瑞芬太尼全麻对腹部手术老年患者麻醉恢复和全麻药物用量的影响。方法:腹部择期手术65岁以上患者40例,随机分为A组(CSI组)和B组(对照组),每组20例,A组通过调控异丙酚复合瑞芬太尼泵入速率维持CSI值在适当范围:术中50～60、术毕前约20分钟60～70,B组根据患者血压、心率等临床体征变化来调节麻醉过程中异丙酚复合瑞芬太尼泵入速率,记录两组患者清醒时间,拔管时间,苏醒室留观时间,麻醉药(异丙酚)的用量,以及各时点平均动脉血压(MAP)、心率(HR)、脉搏指氧饱和度(SpO2)及CSI值。结果:在两组患者年龄、性别、体重及手术时间差异无统计学意义(P>0.05)的情况下,A组麻醉药(异丙酚)的用量较B组明显减少(P<0.01),麻醉过程中,与B组比较,A组的CSI值升高(P<0.05),A组清醒时间、拔管时间、苏醒室留观时间较B组明显减短(P<0.01)。结论:CSI指导异丙酚复合瑞芬太尼全麻能减少全麻药的用量并能加快老年患者麻醉恢复。展开更多
目的探讨麻醉意识深度指数(cerebral state index,CSI)变化在老年男性前列腺电切手术中监测麻醉深度的应用价值。方法选取2016年1月至2017年3月在四川省南充市中心医院全麻下行前列腺电切手术老年患者120例,年龄65~85岁,美国麻醉医师协...目的探讨麻醉意识深度指数(cerebral state index,CSI)变化在老年男性前列腺电切手术中监测麻醉深度的应用价值。方法选取2016年1月至2017年3月在四川省南充市中心医院全麻下行前列腺电切手术老年患者120例,年龄65~85岁,美国麻醉医师协会分级标准(American society of anesthesiologists,ASA)Ⅰ~Ⅲ级。静脉诱导,插入SLIPATM喉罩,术中予以间歇正压通气(intermittent positive pressure ventilation,IPPV),吸入七氟醚,间断推注顺阿曲库铵维持肌松,靶控输注(target controlled infusion,TCI)模式静脉泵注瑞芬太尼。采用随机数字表法,分为CSI组和对照组,每组各60例。记录患者年龄、体质量、文化水平、ASA分级、手术时间、顺阿曲库铵和瑞芬太尼用量,以及麻醉诱导前(T0)、诱导后(T1)、插入喉罩后即刻(T2)和苏醒时(T3)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)和CSI值。记录麻醉苏醒时间(停用七氟烷至能听从指令睁眼时)和拔除喉罩时间(停用七氟烷至拔除喉罩时)。应用简易精神状态量表(mini-mental state examination,MMSE)分别于麻醉前和拔除喉罩后1、6、24、48h评价患者认知功能。结果在麻醉维持期,CSI组患者血流动力学更平稳,差异有统计学意义(P<0.05);CSI组与对照组比较,在睁眼时间和拔除喉罩时间上均明显缩短,差异有统计学意义(P<0.05);MMSE评分与对照组比较,CSI组在麻醉前及拔除喉罩后48h评分,差异无统计学意义(P>0.05),而在拔除喉罩后1、6、24h评分均明显增高,差异有统计学意义(P<0.05)。结论在老年男性前列腺电切手术中,通过CSI为麻醉深度监测提供量化指标,能较为满意地维持患者血流动力学平稳,降低老年患者术后出现认知功能障碍(postoperative cognitive dysfunction,POCD)的概率,增加老年患者麻醉的安全性。展开更多
文摘Carotid angioplasty and stenting (CAS) was developed to be a less invasive and complex procedure compared to carotid endarterectomy (CEA). It has emerged as an alternative for patients who are considered to have high surgical risks due to medical comorbidities or anatomical high-risk features [1]. The procedure is usually done under local anesthesia with light sedation, with the subsequent expectation of less neurologic injury, venous thromboembolisms, and myocardial infarctions—all well-known clinical risks of undergoing surgical procedures under general anesthesia. CAS, however, carries some increased risks of arterial dissection, dislocation of atherothrombotic debris and embolization to the brain or eye, late embolization due to thrombus formation on the damaged plaque, and bradycardia and hypotension as a result of carotid sinus stimulation. Electroencephalography can detect cerebral ischemia and hypoxia along with measuring hypnotic effects, but has not been reported to be used during CAS to signal impending neurological deficit and allow for intervention to prevent stroke. We report on the use of patient state index (PSI), an electroencephalographic (EEG) derived variable used by SEDLine monitor (Masimo Inc., San Diego, CA) to monitor changes in cerebral blood flow during carotid angioplasty and stenting in an awake patient under local anesthesia. PSI was developed to measure the level of hypnosis and sedation during anesthesia and in the ICU. The PSI is based on quantitative electroencephalogram features, recorded from anterior and posterior scalp sites, as input to a multivariate algorithm that quantifies the most probable level of anesthesia or sedation. The PSI is reported as a range from 0 to 100, with decreasing values indicating increasing levels of anesthesia or sedation. Adequate depth of anesthesia is reflected by PSI value of 25 - 50, and a fully awake state by a PSI of 100 [2]. Other EEG analysis techniques have been explored to detect changes in cerebral blood flow during carotid surgery [3], such as entropy described by Khan and Ozcan in his recent work entitled Disagreement in Bilateral State Entropy Values in Carotid Artery Disease [4], but there are no previous reports of the use of PSI during procedural sedation in carotid angioplasty and stenting in an awake patient.
文摘目的:研究麻醉深度指数(Cerebral state inder,CSI)反馈调控老年肿瘤患者靶控输注(Target controlled infusion,TCI)丙泊酚的效果。方法:胃癌及直肠癌根治术126例,年龄≥65岁,ASAⅠ～Ⅱ级,随机分为反馈靶控组和靶控组,每组各63例。反馈组设定CSI=50,两组丙泊酚的血浆靶浓度设定为2μg/ml,舒芬太尼的血浆靶浓度麻醉诱导时1.5ng/ml,麻醉维持时0.3ng/ml。记录基础值(T1)、插管(T2)、插管后5min(T3)、切皮(T4)、肿瘤切除(T5)和手术结束(T6)等时点的MAP、HR、HRV和CSI值的变化,统计丙泊酚的用量。结果:靶控组在插管后5min(T3)、切皮(T4)、切肿瘤(T5)等时点的MAP下降比反馈靶控组明显(P<0.05);HRV在插管后5min(T3)、肿瘤切除(T5)时下降较反馈靶控组明显(P<0.05);反馈靶控组的CSI值波动小于靶控组(P<0.05),丙泊酚的用量也小于靶控组(P<0.05)。结论:麻醉深度指数反馈调控靶控输注丙泊酚对老年肿瘤患者的麻醉安全可行。
文摘目的:探讨脑状态指数(cerebral state index,CSI)指导下异丙酚复合瑞芬太尼全麻对腹部手术老年患者麻醉恢复和全麻药物用量的影响。方法:腹部择期手术65岁以上患者40例,随机分为A组(CSI组)和B组(对照组),每组20例,A组通过调控异丙酚复合瑞芬太尼泵入速率维持CSI值在适当范围:术中50～60、术毕前约20分钟60～70,B组根据患者血压、心率等临床体征变化来调节麻醉过程中异丙酚复合瑞芬太尼泵入速率,记录两组患者清醒时间,拔管时间,苏醒室留观时间,麻醉药(异丙酚)的用量,以及各时点平均动脉血压(MAP)、心率(HR)、脉搏指氧饱和度(SpO2)及CSI值。结果:在两组患者年龄、性别、体重及手术时间差异无统计学意义(P>0.05)的情况下,A组麻醉药(异丙酚)的用量较B组明显减少(P<0.01),麻醉过程中,与B组比较,A组的CSI值升高(P<0.05),A组清醒时间、拔管时间、苏醒室留观时间较B组明显减短(P<0.01)。结论:CSI指导异丙酚复合瑞芬太尼全麻能减少全麻药的用量并能加快老年患者麻醉恢复。
文摘目的探讨麻醉意识深度指数(cerebral state index,CSI)变化在老年男性前列腺电切手术中监测麻醉深度的应用价值。方法选取2016年1月至2017年3月在四川省南充市中心医院全麻下行前列腺电切手术老年患者120例,年龄65~85岁,美国麻醉医师协会分级标准(American society of anesthesiologists,ASA)Ⅰ~Ⅲ级。静脉诱导,插入SLIPATM喉罩,术中予以间歇正压通气(intermittent positive pressure ventilation,IPPV),吸入七氟醚,间断推注顺阿曲库铵维持肌松,靶控输注(target controlled infusion,TCI)模式静脉泵注瑞芬太尼。采用随机数字表法,分为CSI组和对照组,每组各60例。记录患者年龄、体质量、文化水平、ASA分级、手术时间、顺阿曲库铵和瑞芬太尼用量,以及麻醉诱导前(T0)、诱导后(T1)、插入喉罩后即刻(T2)和苏醒时(T3)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)和CSI值。记录麻醉苏醒时间(停用七氟烷至能听从指令睁眼时)和拔除喉罩时间(停用七氟烷至拔除喉罩时)。应用简易精神状态量表(mini-mental state examination,MMSE)分别于麻醉前和拔除喉罩后1、6、24、48h评价患者认知功能。结果在麻醉维持期,CSI组患者血流动力学更平稳,差异有统计学意义(P<0.05);CSI组与对照组比较,在睁眼时间和拔除喉罩时间上均明显缩短,差异有统计学意义(P<0.05);MMSE评分与对照组比较,CSI组在麻醉前及拔除喉罩后48h评分,差异无统计学意义(P>0.05),而在拔除喉罩后1、6、24h评分均明显增高,差异有统计学意义(P<0.05)。结论在老年男性前列腺电切手术中,通过CSI为麻醉深度监测提供量化指标,能较为满意地维持患者血流动力学平稳,降低老年患者术后出现认知功能障碍(postoperative cognitive dysfunction,POCD)的概率,增加老年患者麻醉的安全性。
