Assessment of depth of anesthesia using principal component analysis

A new approach to estimating level of uncon-sciousness based on Principal Component Analysis (PCA) is proposed. The Electroen-cephalogram (EEG) data was captured in both Intensive Care Unit (ICU) and operating room, using different anesthetic drugs. Assuming the central nervous system as a 20-tuple source, window length of 20 seconds is applied to EEG. The mentioned window is considered as 20 nonoverlapping mixed-signals (epoch). PCA algorithm is applied to these epochs, and larg-est remaining eigenvalue (LRE) and smallest remaining eigenvalue (SRE) were extracted. Correlation between extracted parameters (LRE and SRE) and depth of anesthesia (DOA) was measured using Prediction probability (PK). The results show the superiority of SRE than LRE in predicting DOA in the case of ICU and isoflurane, and the slight superiority of LRE than SRE in propofol induction. Finally, a mixture model containing both LRE and SRE could predict DOA as well as Relative Beta Ratio (RBR), which expresses the high capability of the proposed PCA based method in estimating DOA.

Evaluation of EEG β2/θ -ratio and channel locations in measuring anesthesia depth

In this paper, the ratio of powers in the frequency bands of β2 and θ waves in EEG signals (termed as the β2/θ -ratio) was introduced as a potential enhancement in measuring anesthesia depth. The β2/θ -ratio was compared to the relative β-ratio which had been commercially used in the BIS monitor. Sensitivity and reliability of the β2/θ -ratio and EEG measurement locations were analyzed for their effectiveness in measuring anesthesia depth during different stages of propofol induced anesthesia (awake, induction, maintenance, and emergence). The analysis indicated that 1) the relative β -ratio and β2/θ-ratio derived from the prefrontal, frontal, and the central cortex EEG signals were of substantial sensitivity for capturing anesthesia depth changes. 2) Certain channel positions in the frontal part of the cortex, such as , had the combined benefits of substantial sensitivity and noise resistance. 3) The β2/θ-ratio captured the initial excitation, while the relative β -ratio did not. 4) In the maintenance and emergence stages, the β2/θ -ratio showed improved reliability. Implications: The ratio of powers in EEG frequency bands and derived from the frontal cortex EEG channels has combined benefits of substantial sensitivity and noise resistance in measuring anesthesia depth.

NONINVASIVE DETECTION OF BRAIN ACTIVITY VARIATION UNDER DIFFERENT DEPTH OF ANESTHESIA BY EEG COMPLEXITY

Objective To detect the change of brain activity under different depth of anesthesia (DOA) noninvasively. Methods The Lempel-Ziv complexity C(n) was used to analyze EEG and its four components (delta, theta, alpha, beta), which was recorded from SD rats under different DOA. The relationship between C(n) and DOA was studied. Results The C(n) of EEG will decrease while the depth of anesthesia increasing and vice versa. It can be used to detect the change of DOA sensitively. Compared with power spectrum, the change of C(n) is opposite to that of power spectrum. Only the C(n) of delta rhythm has obvious variations induced by the change of DOA, and the variations of delta is as similar as the EEG's. Conclusion The study shows that the desynchronized EEG is replaced by the synchronized EEG when rat goes into anesthesia state from awake, that is just the reason why complexity and power spectrum appear corresponding changes under different DOA. C(n) of delta rhythm dynamic change leads to the change of EEG, and the delta rhythm is the dominant rhythm during anesthesia for rats.

Effects of different anesthesia depth on the level of plasma cortisol during operation and the score of postoperative MMSE in elderly patients with radical operation for gastric carcinoma

Objective:To observe the effects of different anesthesia depths on the level of plasma cortisol during operation and the score of postoperative MMSE in elderly patients underwent radical gastrectomy.Methods: A total of eighty seven elderly patients undergoing radical gastrectomy were enrolled in this study. Continuous infusion of propofol and remifentanil for anesthesia and maintenance of propofol were divided into two groups: BIS-I (BIS: 45-55) and BIS-II (BIS: 55-65) by adusting the doses of propofol. The data were recorded as following, thewhole dosage of propofol, the time of extubation and the score of VAS. The level of plasma cortisol was finished at the time of incision and tracheal intubation. MMSE scores were recorded on the day before operation and follow-up at 3 and 7 d postoperatively. Record the patient's operation to discharge time, postoperative complications.Results: The concentration of cortisol in BIS-I group was higher than that in BIS-II group. There was no significant difference in extubation time, extubation VAS score and MMSE score after operation.Conclusion:There were no significant differences in the BIS values between 45 and 65 for the elderly patients undergoing upper abdominal surgery, and there were no significant differences in the patients' postoperative stress, wake, extubation, early postoperative pain scores and postoperative cognitive function. BIS values in 45-55 compared to 55-65 patients with low plasma cortisol levels may be associated with better control of stress levels, to maintain the BIS value between 45-55 anesthesia depths is more reasonable.

Effect of anesthesia depth on the stress reaction and cognitive level in elderly patients underwent minimally invasive cholecystectomy

Objective: To observe the effect of anesthesia depth on the stress reaction and cognitive level in elderly patients underwent minimally invasive cholecystectomy in order to provide a basis for the selection of anesthesia depth. Methods: A total of 90 elderly patients with gallstone who were admitted in our hospital for laparoscopic cholecystectomy (LC) were included in the study and randomized into the observation I, II, and III groups. Narcotrend (NT) was used to monitor the anesthesia depth during operation in the three groups, and the anesthesia depth was maintained at D0, D1, and D2 levels, respectively. The vital signs before anesthesia induction, before and after tracheal intubation, before and after operation, and extubation in the three groups were monitored and recorded. ACTH, COR, and TNF-α levels before anesthesia induction, before and after operation, 1 and 4 d after operation were detected. MOCA and MMSE were used to evaluate the cognition 1d before operation and 4d after operation. Results: The fluctuation of MAP and HR after tracheal intubation, before and after operation, and extubation in observation III group was the smallest. COR level before operation in observation I group was significantly higher than that in observation III group, while COR level after operation was significantly higher than that in the observation II and III groups, and COR level before and after operation in observation II group was significantly higher than that in observation III group. ACTH level before and after operation in observation I and II groups was significantly higher than that in observation III group. The comparison of TNF-α level at each timing-point among the three groups was not statistically significant. The comparison of MOCA and MMSE scores 1d before operation and 4d after operation among the three groups was not statistically significant. Conclusions: The anesthesia depth maintaining at D2 level for elderly patients during perioperative period of LC is more beneficial to maintain the stability of haemodynamics, and reduce the stress reaction.

Influence of different anesthesia depths on cerebral oxygen metabolism and stress response during general anes thesia surgery as well as postoperative cognitive function in elderly patients

Objective: To study the influence of different anesthesia depths on the cerebral oxygen metabolism and stress response during general anesthesia surgery as well as the postoperative cognitive function in elderly patients. Method: Prospective study was designed, and the elderly patients undergone general anesthesia surgery in our hospital between March 2015 and March 2017 were selected and randomly divided into the three groups: group A with Narcotrend index 25-35;the group B with Narcotrend index 35-45;the group C with Narcotrend index 45-55. Before induction (T0), during surgery (T1), at extubation (T2) and 30 min after extubation (T3), cerebral oxygen metabolism indexes arterio-venous oxygen content difference (Da-jvO2) and cerebral oxygen extraction rate as well as stress indexes norepinephrine, epinephrine, cortisol and growth hormone were measured;1, 3, 5 and 7 d after surgery, mini-mental state examination was adopted to evaluate cognitive function, and the serum neuron-specific enolase, S100B and β amyloid 1-42 were measured. Results: At T1, T2 and T3, Da-jvO2 levels of group A and group B were obviously higher than those of group C whereas cerebral oxygen extraction rate levels as well as serum norepinephrine, norepinephrine, cortisol and growth hormone contents were lower than those of group C;1, 3, 5 and 7 d after surgery, mini-mental state examination scores of group B and group C were significantly higher than those of group A, while serum neuron-specific enolase, S100B and β amyloid 1-42 contents of group B and group C were significantly lower than those of group A. Conclusion: The anesthesia depth with Narcotrend index 35-45 can control cerebral oxygen metabolism, reduce stress response and improve postoperative cognitive function.

Wavelet and pain rating index for inhalation anesthesia: A randomized controlled trial

BACKGROUND Wavelet index(WLi)and pain rating index(PRi)are new parameters for regulating general anesthesia depth based on wavelet analysis.AIM To investigate the safety and efficacy of using WLi or PRi in sevoflurane anesthesia.METHODS This randomized controlled trial enrolled 66 patients scheduled for elective posterior lumbar interbody fusion surgery under sevoflurane anesthesia between September 2017 and February 2018.A random number generator was used to assign the eligible patients to three groups:Systolic blood pressure(SBP)monitoring group,WLi monitoring group,and PRi monitoring group.The main anesthesiologist was aware of the patient grouping and intervention used.The primary endpoint was anesthesia recovery time.Secondary endpoints included extubation time,sevoflurane consumption,number of unwanted events/interventions,number of adverse events and postoperative visual analogue scale for pain.RESULTS A total of 62 patients were included in the final analysis(SBP group,n=21;WLi group,n=21;and PRi group,n=20).There were no significant differences among the three groups in patient age,gender distribution,body mass index,American Society of Anesthesiologists class,duration of surgery,or duration of anesthesia.Anesthesia recovery time was shorter in the WLi and PRi groups than in the SBP group with no significant difference between the WLi and PRi groups.Extubation time was shorter in the WLi and PRi groups than in the SBP group.Sevoflurane consumption was lower in the WLi and PRi groups than in the SBP group.Nicardipine was more commonly needed to treat hypertension in the WLi and PRi groups than in the SBP group.CONCLUSION Regulation of sevoflurane anesthesia depth with WLi or PRi reduced anesthesia recovery time,extubation time and sevoflurane consumption without intraoperative unwanted events.

Multi-outcome predictive modelling of anesthesia patients

Conjunctive use of anesthetic agents results in drug interactions which can alter or influence multiple patient outcomes such as anesthesia depth,and cardiorespiratory parameters which can also be altered by patient conditions and surgical procedures.Using artificial intelligence technology to continuously gather data of drug infusion and patient outcomes,we can generate reliable computer models individualized for a patient during specific stages of particular surgical procedures.This data can then be used to extend the current anesthesia monitoring functions to include future impact prediction,drug administration planning,and anesthesia decisions.

Optimizing anesthesia depth to enhance seizure quality during electroconvulsive therapy in major depressive disorder

This editorial evaluated the findings of a comprehensive study focused on the effects of anesthesia depth on seizure parameters during electroconvulsive therapy(ECT)in patients with major depressive disorder.The study utilized quantitative consciousness and quantitative nociceptive indices for monitoring sedation,hypnosis,and nociceptive responses.The analysis included 193 ECT sessions across 24 patients,revealing significant impacts of anesthesia depth on electroencephalography(EEG)seizure parameters.Key findings include that lighter anesthesia resulted in longer EEG seizure duration and higher post-ictal suppression index,without increasing complications.These insights emphasize the importance of optimal anesthesia management to improve therapeutic outcomes in ECT.

Signal averaging for noise reduction in anesthesia monitoring and control with communication channels

This paper investigates impact of noise and signal averaging on patient control in anesthesia applications, especially in networked control system settings such as wireless connected systems, sensor networks, local area networks, or tele-medicine over a wide area network. Such systems involve communication channels which introduce noises due to quantization, channel noises, and have limited communication bandwidth resources. Usually signal averaging can be used effectively in reducing noise effects when remote monitoring and diagnosis are involved. However, when feedback is intended, we show that signal averaging will lose its utility substantially. To explain this phenomenon, we analyze stability margins under signal averaging and derive some optimal strategies for selecting window sizes. A typical case of anesthe-sia depth control problems is used in this development.

Effects of different anesthetic depths on cardiovascular response, stress level and immune function in patients undergoing radical gastrectomy

Objective:To investigate the effects of different anesthesia depth on cardiovascular response, stress level and immune function in patients undergoing radical gastrectomy for gastric cancer.Methods: Ninety-two patients who underwent radical gastrectomy in our hospital from January 2017 to June 2018 were randomly divided into group A (46 cases) and group B (46 cases). Group A received deep anesthesia (BIS:35~45) and group B received shallow anesthesia (BIS:55~65). The changes of heart rate (HR), mean arterial pressure (MAP), cortisol (Cor), adrenocorticotropic hormone (ACTH), epinephrine (E), norepinephrine (NE) and T cell subsets were compared between the two groups at different time points.Results:At T2, T3, and T4, the MAP of group B was (90.37±16.34) mmHg, (105.36±13.27) mmHg, and (86.26±15.34) mmHg, which were higher than group A, and the difference was statistically significant (P<0.05);There was no significant difference in MAP between the two groups at T1, T5 and T6 (P>0.05). There was no significant difference in HR between the two groups at each time point (P>0.05). Before anesthesia, there were no significant differences in Cor, ACTH, E, and NE between the two groups (P>0.05). At the end of surgery and 24 h after surgery, Cor, ACTH, E, and NE were higher than those before anesthesia, and the difference was statistically significant (P<0.05). At the end of surgery and 24 h after surgery, Cor, ACTH, E, and NE in group B were (164.28±40.27) ng/mL, (57.85±18.66) pg/mL, (33.36±5.83) mmol/L, (301.29±41.74) mmol/L, and (156.27±44.28) ng/mL, (50.85±11.40) pg/mL, (27.65±4.78) mmol/L, (267.22±38.21) mmol/L, both higher than group A, the difference was statistically significant (P<0.05). Before anesthesia, there was no significant difference in CD3+, CD4+, CD4+/CD8+ between the two groups (P>0.05). At the end of surgery and 24 h after surgery, the CD3+, CD4+, CD4+/CD8+ levels in the two groups were lower than those before anesthesia, and the difference was statistically significant (P<0.05). At the end of surgery and 24 h after surgery, CD3+, CD4+, CD4+/CD8+ in group B were (51.00±6.10)%, (26.85±4.31)%, (1.15±0.19), and (44.41±4.21)%, (22.41±2.51)%, (1.06±0.29), all lower than group A, the difference was statistically significant (P<0.05). There was no significant difference in CD8 level between the two groups at different time points (P>0.05).Conclusion:The effect of deep anesthesia (BIS: 35~45) on cardiovascular response, stress level and immune function in patients undergoing radical gastrectomy was milder than that of light anesthesia (BIS: 55-65).

不同麻醉深度指数下拔管在扁桃体低温等离子射频消融术患儿中的应用效果比较

目的:比较不同麻醉深度指数(NT值)下拔管在扁桃体低温等离子射频消融术患儿中的应用效果。方法:选取2021年7月至2022年4月于该院行扁桃体低温等离子射频消融术的76例患儿进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各38例。两组均行气管插管全身麻醉,对照组于NT值为95~100时拔管,观察组于NT值为80~94时拔管。比较两组不同时间[停止麻醉维持即刻(T_(0))、拔管后即刻(T_(1))、拔管后10 min(T_(2))]血流动力学指标(心率、平均动脉压、呼吸频率)水平、不同时间(拔管前、拔管后30 min)应激指标[皮质醇(Cor)、肾上腺素(E)]水平、不同时间(T_(0)、T_(1)、T_(2))局部脑氧饱和度(rSO_(2))水平和不良反应发生率。结果:T_(1)、T_(2)时,两组平均动脉压、心率、呼吸频率均高于T_(0)时,但观察组低于对照组,差异有统计学意义(P<0.05);拔管后30 min,两组Cor、E水平均高于拔管前,但观察组低于对照组,差异有统计学意义(P<0.05);T_(0)、T_(1)、T_(2)时,两组rSO_(2)水平比较,差异均无统计学意义(P>0.05);观察组不良反应发生率为5.26%(2/38),低于对照组的21.05%(8/38),差异有统计学意义(P<0.05)。结论:NT值为80~94时拔管应用于扁桃体低温等离子射频消融术患儿可改善血流动力学指标和应激指标水平,降低不良反应发生率,效果优于NT值为80~94时拔管。

国内外麻醉深度脑电监测设备的现状与发展展望

介绍了国内外麻醉深度脑电监测设备的分类、原理及发展现状,分析了麻醉深度脑电监测设备的应用情况及其优缺点,指出了利用多模态监测技术和人工智能技术、提高患者舒适性和安全性、实现数据共享和跨学科合作等是麻醉深度脑电监测设备未来的发展趋势。

右美托咪定对丙泊酚靶控输注复合舒芬太尼麻醉期间麻醉深度的影响

目的探讨丙泊酚靶控输注与舒芬太尼复合麻醉期间患者采用右美托咪定(DEX)对麻醉深度的影响。方法选取2021年8月至2022年7月在郑州市第三人民医院接受甲状腺次全切除术患者共计90例,均行丙泊酚靶控输注与舒芬太尼复合麻醉,根据随机数字表法分为研究组(n=45)与对照组(n=45),研究组静脉泵注DEX稀释药物+生理盐水,对照组静脉泵注生理盐水(同等剂量),对两组熵指数(EI)变化情况(诱导后、操作时、手术结束后)进行观察,对两组平均动脉压(MAP)、心率(HR)、警觉/镇静评分(OAA/S)进行记录[给药前(T_(0))、给药5 min(T_(1))、给药10 min(T_(2))、给药20 min(T_(3))],统计两组麻醉恢复时间。结果两组诱导后、操作时、手术结束后的反应熵(RE)和状态熵(SE)降低,差异有统计学意义(P<0.05),且研究组与对照组相比更低,差异有统计学意义(P<0.05);两组T_(1)、T_(2)时MAP升高,差异有统计学意义(P<0.05),T_(1)、T_(2)、T_(3)时HR下降,差异有统计学意义(P<0.05),T_(1)、T_(2)、T_(3)时OAA/S评分降低,差异有统计学意义(P<0.05),研究组T_(1)、T_(2)时MAP较对照组更高,差异有统计学意义(P<0.05),研究组T_(2)、T_(3)时HR更低,差异有统计学意义(P<0.05),研究组T_(2)、T_(3)时OAA/S评分更高,差异有统计学意义(P<0.05);研究组呼吸睁眼时间、拔管时间较对照组更短,差异有统计学意义(P<0.05)。结论DEX应用于丙泊酚靶控输注与舒芬太尼复合麻醉患者可提高麻醉质量,稳定血流动力学,镇静效果显著,缩短麻醉恢复时间。

不同麻醉深度对老年患者全麻术后脑损伤指标及炎症因子的影响

目的:探讨推荐脑电双频谱指数(BIS)范围内维持不同麻醉深度对老年患者全麻术后脑损伤指标及炎症因子的影响。方法:选取2021年于温州医科大学附属第一医院择期行腹腔镜消化道肿瘤手术老年患者40例,根据随机数字表法将入选患者随机分为BIS40组和BIS55组,每组20例。两组均采用静脉诱导,吸入麻醉维持相应麻醉深度,其中BIS40组患者术中维持BIS值于40~45,BIS55组患者BIS维持于55~60。分别于诱导前(T0)、诱导完成后(T1)、气腹后即刻(T2)、取标本(T3)、冲洗(T4)、术毕(T5)、拔管(T6)和回病房(T7)即刻记录患者血流动力学指标;分别于术前、术后2、6和24 h采集静脉血测定血清脑红蛋白(NGB)、低氧诱导因子(HIF-α)、神经元特异性烯醇化酶(NSE)、S100-β、IL-6和TNF-α。结果:与BIS55组比较,BIS40组患者七氟烷用量更大,BIS值更低,且拔管所需时间延长(P<0.05)。BIS40组患者术后2 h血清TNF-α和IL-6水平低于BIS55组(P<0.05),其余时间点TNF-α和IL-6水平差异无统计学意义(P>0.05);各时点血清NGB、NSE、S100-β和HIF-α水平2组间差异均无统计学意义(P>0.05)。结论:推荐BIS范围内不同麻醉深度不影响老年患者全麻术后脑损伤指标,但BIS值于40~45的患者术后早期炎症因子水平更低。

瑞马唑仑复合瑞芬太尼喉罩静脉麻醉在输尿管镜碎石手术中的效果

目的 探讨瑞马唑仑复合瑞芬太尼喉罩静脉麻醉对输尿管镜碎石手术患者镇静深度及血流动力学的影响。方法 回顾性分析75例行输尿管镜碎石手术患者的临床资料,按照麻醉方式不同将入选患者分为A组(n=37)和B组(n=38),A组采用常规喉罩静脉麻醉,B组采用瑞马唑仑复合瑞芬太尼喉罩静脉麻醉,比较2组的镇静深度、麻醉效果、血流动力学[麻醉诱导前(t0)、置入喉罩时(t_(1))、手术开始时(t_(2))、拔除喉罩后5 min(t_(3))的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)和血氧饱和度(oxygen saturation,SpO_(2))]变化情况及术后(30 min、4 h和8 h)躁动发生情况。结果 2组患者意识消失时间和行机械通气前的脑电双频指数(Bi-spectral index,BIS)值比较,差异均无统计学意义(P>0.05);B组术中体动次数、自主呼吸恢复时间、睁眼时间及言语应答时间均明显短于A组(P<0.05);与t_(0)时刻比较,A组t_(1)~t_(3)时刻MAP、HR及t_(3)时刻SpO_(2)均显著降低(P<0.05),B组t_(1)~t_(3)时刻MAP、HR均显著降低(P<0.05),但B组t_(1)~t_(3)时刻MAP、HR明显高于同期A组(P<0.05);术后30 min、4 h和8 h,B组术后躁动发生率均显著低于A组(P<0.05)。结论 输尿管镜碎石手术中应用瑞马唑仑复合瑞芬太尼喉罩静脉麻醉可取得较好的镇静深度和麻醉效果,有助于稳定患者的血流动力学,减少术后躁动发生,且安全性较高。

脑电双频指数指导下不同麻醉深度对老年创伤性髋部骨折患者术后谵妄的影响

目的:探讨脑电双频指数(BIS)指导下不同麻醉深度对老年创伤性髋部骨折患者术后谵妄(POD)的影响,并探索最佳麻醉深度。方法:选择拟在全麻下行髋部手术治疗的老年患者75例,分为常规麻醉组(N组,根据生命体征变化调整用药并记录BIS值)、高目标值组(B1组,维持BIS值在51~60)和低目标值组(B2组,维持BIS值在40~50),每组25例。记录麻醉诱导前(T_(0))、切皮(T_(1))、术中(T_(2),自切皮起1 h)、拔管(T_(3))、离室时(T_(4))的平均动脉压(MAP)和心率(HR),入室及术毕时血糖变化情况,术中丙泊酚、瑞芬太尼用量,以及术后苏醒时间、苏醒时Steward评分和离室时间。采用改良Brice调查问卷判断患者术中知晓发生情况。采用谵妄评定量表(CAM-CR)分别于术后24、48、72 h评估各组POD发生率。采用简易精神状态评价量表(MMSE)分别于术后24、72 h评估患者术后认知功能情况。采用视觉模拟评分量表(VAS)于术后8、12、24 h评估患者术后疼痛情况。记录术后恶心呕吐发生情况及术后住院天数。结果:术后24 h,B1组POD发生率低于N组及B2组,MMSE评分高于N组及B2组(均P<0.05)。三组术后48、72 h时POD发生率比较差异无统计意义(均P>0.05)。术后72 h时,MMSE评分B1组最高,B2组次之,N组最低(均P<0.05)。与N组比较,B2组患者术毕血糖水平低(P<0.05)。在T_(0)时点,三组MAP与HR比较差异无统计学意义(均P>0.05)。在T_(1)时点,N组MAP及HR高于B1、B2组(均P<0.05)。在T_(2)时点,B1组MAP最高,N组次之,B2组最低(均P<0.05);N组及B1组HR高于B2组(均P<0.05)。在T_(3)时点,N组及B2组MAP及HR高于B1组(均P<0.05)。在T_(4)时点,三组患者MAP及HR比较差异无统计学意义(均P>0.05)。相较于B1组,N组和B2组丙泊酚用量增加(均P<0.05)。三组瑞芬太尼用量比较差异无统计学意义(P>0.05)。相较于B1组,N组与B2组苏醒时Steward评分降低,苏醒时间和离室时间增加(均P<0.05)。三组均未发生术中知晓。三组术后恶心呕吐及VAS评分比较差异无统计学意义(均P>0.05)。B1组术后住院天数低于N组、B2组(均P<0.05)。结论:术中行BIS监测可减少老年创伤性髋部骨折患者POD发生率,且BIS值维持在51~60为其最佳麻醉深度。

麻醉深度监测仪引导下不同麻醉深度对老年结肠癌腹腔镜术后苏醒质量的影响

目的:探究麻醉深度监测仪引导下不同麻醉深度对老年结肠癌患者术后苏醒质量的影响。方法:选取2017年2月至2020年6月北京市昌平区医院收治的96例行手术切除的结肠癌老年患者,依照随机抽样的方式将其分为麻醉浅度组、中度组和深度组,每组32例。深度组脑电波双谱指数(BIS)在30~39区间内,中度组BIS在40~49区间内,浅度组BIS在50~60区间内。观察麻醉深度监测仪引导下不同麻醉深度下患者Prince-Henry疼痛量表评分;监测术前(S1)、术成(S2)及术后(S3)3个时期患者促肾上腺皮质激素(ACTH)、皮质醇(Cor)及白细胞介素6(IL-6)应激反应相关指标;以及并发症发生率和认知功能的差异。结果:3组结肠癌患者术后Prince-Henry疼痛评分比较显示,不同麻醉深度的组间差异无统计学意义(P>0.05)。ACTH、Cor及IL-6的应激反应指标在不同麻醉深度组中表现出显著的时间依赖性变化。S2点所有组别的应激反应指标显著增高,浅度组ACTH、Cor和IL-6指标分别为(13.73±1.63)nmol/L、(269.24±31.46)nmol/L和(83.67±3.44)ng/L,中度组分别为(18.26±2.52)nmol/L、(242.56±36.75)nmol/L和(109.35±6.44)ng/L,深度组分别为(19.42±2.42)nmol/L、(432.35±31.34)nmol/L和(132.42±2.31)ng/L,与同组S1比较差异均有统计学意义(t_(浅度组)=7.99、12.48、16.48,t_(中度组)=2.19、6.82、3.03,t_(深度组)=14.21、5.11、20.14,P<0.05)。并发症的发生率中浅度组与中度和深度组比较,差异均有统计学意义(x2=6.342、5.238,P<0.05)。3组术后24 h的MMSE评分显示,浅度组、中度组与深度组比较,差异均有统计学意义(t=4.74、3.77,P<0.05)。结论:麻醉深度对术后恢复质量、应激反应和认知功能有重要影响。利用麻醉深度监测仪调节不同麻醉深度,有助于提高老年结肠癌患者术后的苏醒质量,并减少不良反应发生率。

不同剂量甲苯磺酸瑞马唑仑全麻诱导对老年患者镇静深度的影响

目的:探讨不同剂量甲苯磺酸瑞马唑仑全麻诱导对老年患者镇静深度的影响。方法:选取2020年1月—2021年12月广州医科大学附属第一医院收治110例采用甲苯磺酸瑞马唑仑全麻诱导的老年患者,按照随机数表法分成观察组与对照组,各55例。观察组甲苯磺酸瑞马唑仑诱导剂量为0.3 mg/kg,对照组甲苯磺酸瑞马唑仑诱导剂量为0.2 mg/kg。比较两组达到深度麻醉时间、生命体征、不良反应、药物补救情况。结果:观察组达到深度麻醉时间明显短于对照组,差异有统计学意义(P<0.05);两组心率、每搏量指数、平均动脉压(MAP)比较,差异无统计学意义(P>0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。观察组药物补救发生率低于对照组,差异有统计学意义(P<0.05)。结论:高剂量甲苯磺酸瑞马唑仑全麻诱导应用于老年患者后起效速度更快,不会对患者生命体征造成严重影响,且药物补救概率低。

不同麻醉深度对老年腹部手术患者术后认知功能的影响

目的:探讨不同麻醉深度对老年腹部手术患者术后认知功能的影响。方法:选取78例老年腹部手术患者作为研究对象,依据脑电双频指数(BIS)不同将患者分为对照组(浅麻醉,BIS≥45)和研究组(深麻醉,30<BIS<45),每组各39例。比较两组患者手术相关指标、血流动力学指标、白细胞介素6(IL-6)水平、中枢神经特异蛋白(S-100β)水平、简易精神状态检查表(MMSE)评分及术后认知功能障碍(POCD)发生率。结果:两组患者输液量、麻醉时间、术中出血量比较,差异均无统计学意义(P>0.05);研究组苏醒时间、拔管时间长于对照组(P<0.05);两组患者术后1、3 d,血清IL-6、S-100β水平先升高后降低(P<0.05),且研究组术后各时间均低于对照组(P<0.05);在麻醉后研究组T1、T2时间点的平均动脉压均高于对照组,T1、T2心率均低于对照组(P<0.05);术后1、3 d,研究组MMSE评分高于对照组;术后1、3、7 d,研究组POCD发生率均低于对照组(P<0.05)。结论:深度麻醉(BIS:30~45)可降低老年腹部手术患者发生POCD的几率及血清IL-6和S-100β水平,在减轻中枢神经系统损伤方面具有积极作用。