年龄对脑电图麻醉指标的影响

2021
11/24

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年龄对脑电图麻醉指标的影响

本文由“罂粟花”授权转载

年龄对脑电图麻醉指标的影响  

贵州医科大学麻醉与心脏电生理课题组  

翻译:安丽 编辑:陈锐 审校:曹莹

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研究目的

 在未来的几年里,将会有越来越多的老年患者需要全身麻醉。由于年龄是术后谵妄的独立危险因素,术后谵妄的发生率也随之增加。降低POD风险的一种方法是: 使用神经监测来指导麻醉用量,以避免过高剂量的麻醉药的使用。因此,我们评估了患者年龄对各种以脑电图(EEG)为基础的麻醉指标的影响。

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设计与患者

我们通过将需维持全身麻醉(年龄18-90岁;ASA I-IV)的180名患者,通过单电极EEG监测系统,对其指标进行了评价。我们纳入了状态/反应熵、麻醉趋势、qCON/qNOX、双谱指数(BIS)和Treaton MGA-06,我们从BIS中提取了光谱边缘频率(SEF)。为了评估年龄的影响,我们建立了线性回归模型来评估各种指标之间的相关性。

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主要结果

在麻醉维持期间,SEF、状态/反应熵、qCON/qNOX和BIS值均随患者年龄显著增加(0.05 Hz/0.19–0.26个指数点/年)(p < 0.001);而麻醉趋势随年龄变化不明显(0.06个指数点/年;p=0.28)。治疗装置的指数值随着年龄的增长而显著降低(−0.09个指数点/年;p<0.001)。这些发现与给药剂量无关。

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结论

目前几乎所有现有的神经监测设备都受年龄的影响,有可能导致不适当的高剂量麻醉。因此,麻醉医师应该意识到这种现象,下一代的监护仪应该纠正这些变化。

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原始文献来源   

Obert DP,  Schweizer C,  Zinn S,  Kratzer S,  Hight D,  Sleigh J,  Schneider G,  García PS,  Kreuzer M.The influence of age on EEG-based anaesthesia indices.J Clin Anesth 2021 Oct;73.DOI:10.1016/j.jclinane.2021.110325


The influence of age on EEG-based anaesthesia indices

Abstract

Study objective: In the upcoming years there will be a growing number of elderly patients requiring general anaesthesia. As age is an independent risk factor for postoperative delirium (POD) the incidence of POD will increase concordantly. One approach to reduce the risk of POD would be to avoid excessively high doses of anaesthetics by using neuromonitoring to guide anaesthesia titration. Therefore, we evaluated the influence of patients age on various electroencephalogram (EEG)-based anaesthesia indices.


Design and patients: We conducted an analysis of previously published data by replaying single electrode EEG episodes of maintenance of general anaesthesia from 180 patients (1890 years; ASA I-IV) into the five different commercially available monitoring systems and evaluated their indices. We included the State/Response Entropy, Narcotrend, qCON/qNOX, bispectral index (BIS), and Treaton MGA-06. For a non-commercial comparison, we extracted the spectral edge frequency (SEF) from the BIS. To evaluate the influence of the age we generated linear regression models. We also assessed the correlation between the various indices.


Main results: During anaesthetic maintenance the values of the SEF, State/Response Entropy, qCON/qNOX and BIS all significantly increased (0.05 Hz/0.190.26 index points per year) with the patients age (p < 0.001); whereas the Narcotrend did not change significantly with age (0.06 index points per year; p = 0.28). The index values of the Treaton device significantly decreased with age (0.09 index points per year; p < 0.001). These findings were independent of the administered dose of anaesthetics.


Conclusions: Almost all current neuromonitoring devices are influenced by age, with the potential to result in inappropriately high dosage of anaesthetics. Therefore, anaesthesiologists should be aware of this phenomenon, and the next generation of monitors should correct for these changes.

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关键词:
麻醉,年龄,指标,患者

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