Background There are few studies to assess whether the effect-site concentration of propofol can predict anesthetic depth during the target-controlled infusion （TCI） induction in elderly patients. This study aimed t...Background There are few studies to assess whether the effect-site concentration of propofol can predict anesthetic depth during the target-controlled infusion （TCI） induction in elderly patients. This study aimed to evaluate the relationship between effect-site concentration of propofol and depth of anesthesia during the TCI induction in elderly patients. Methods Ninety patients （60-80 years） with an American Society of Anesthesiologists （ASA） physical status of 1-3, undergoing scheduled abdominal and thoracic surgery under general anesthesia were randomly allocated into one of three groups, Group S1, S2 and S3 （30 patients in each group）. The patients in Group S1 received propofol with a target plasma concentration of 4.0 pg/ml; patients in Group S2 received propofol with an initial target plasma concentrations of 2.0 IJg/ml that was raised to 4.0 pg/ml 3 minutes later; patients in Group S3 received an infused scheme of 3 steps; starting from a target plasma concentration of 2.0 pg/ml that was increased stepwised by 1 pg/ml until a target plasma concentration of 4.0 pg/ml was achieved, the interval between the two steps was 3 minutes. When an Observer＇s Assessment of Alertness/Sedation （OANS） score of 1 was achieved, remifentanil （effect-site concentration （Ce） of 4.0 ng/ml） and rocuronium 0.9 mg/kg were administered. Tracheal intubation was started 2 minutes after rocuronium injection. Changes of propofol Ce, blood pressure （BP）, heart rate （HR）, and bispectral index （BIS） were recorded. Results When an OAA/S score of 1 was achieved, Ce of propofol were （1.7±0.4） pg/ml, （1.9±0.3） pg/ml, （1.9±0.4） pg/ml and the BIS values were 64±5, 65±8, and 62±8 in Groups S1, S2 and S3. Before intubation, Ce of propofol was （2.8±0.2） pg/ml, （2.8±0.3） pg/ml, （2.7±0.3） pg/ml, and the BIS values were 48±7, 51±7, and 47±5 in Groups S1, S2 and S3. By linear regression analysis, a significant correlation between Ce of propofol and BIS values was found （r=-0.580, P 〈0.01）. Systolic blood pressure （SBP） before intubation was significantly lower in Group S1 than in Groups S2 and S3. SBP and HR after intubation in the three groups were significantly increased when compared with pre-intubation values, but they did not exceed baseline values Conclusions During the TCI induction, Ce of propofol with （1.9±0.3） pg/ml may make the elderly patients unconscious. When remifentanil with a Ce of 4.0 ng/ml is added a Ce of propofol with （2.8±0.3） pg/ml is suitable for intubation. The Ce of propofol has a close correlation with the BIS values. Also, a two-step TCI technique seems to be a more suitable method of anesthesia induction in elderly patients compared with the no-stepwise TCI technique and three-step TCI technique.展开更多
目的观察帕金森病(Parkinson’s disease,PD)患者与非PD患者丙泊酚诱导意识消失所需的效应室浓度(effect-site concentration,Ce)。方法纳入2022年10月16日至2023年10月14日于首都医科大学附属北京天坛医院就诊的患者,筛选年龄50~80岁,...目的观察帕金森病(Parkinson’s disease,PD)患者与非PD患者丙泊酚诱导意识消失所需的效应室浓度(effect-site concentration,Ce)。方法纳入2022年10月16日至2023年10月14日于首都医科大学附属北京天坛医院就诊的患者,筛选年龄50~80岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅱ-Ⅲ级,行双侧脑深部电刺激手术的PD患者(PD组),并按照年龄和性别匹配选取同期行非神经外科非心脏手术的非PD患者(Non-PD组)各37例为研究对象。采用Schnider模型靶控泵注丙泊酚,警觉/镇静观察(Observer’s Assessment of Alertness/Sedation,OAA/S)评分达1分后20 s评估意识状态,采集5 min临床试验数据后停药,记录给药后OAA/S评分1分时、停药后OAA/S评分3分时丙泊酚的Ce、患者状态指数(patient state index,PSI)。结果PD患者组诱导至无意识状态所需丙泊酚剂量明显少于Non-PD患者组[(2.2±0.4)mg/L vs(3.1±0.4)mg/L,P<0.05];与Non-PD患者比较,PD患者意识消失和意识恢复时的PSI值更高(P<0.05),意识恢复时间明显延长(P<0.05),意识恢复时丙泊酚Ce更低(P<0.05)。结论PD患者诱导意识消失所需的丙泊酚剂量降低,且需要在更低的Ce下苏醒,苏醒时间明显长于非PD患者,在意识消失和苏醒时的PSI均高于非PD患者,麻醉管理中应予以重视。展开更多
文摘Background There are few studies to assess whether the effect-site concentration of propofol can predict anesthetic depth during the target-controlled infusion （TCI） induction in elderly patients. This study aimed to evaluate the relationship between effect-site concentration of propofol and depth of anesthesia during the TCI induction in elderly patients. Methods Ninety patients （60-80 years） with an American Society of Anesthesiologists （ASA） physical status of 1-3, undergoing scheduled abdominal and thoracic surgery under general anesthesia were randomly allocated into one of three groups, Group S1, S2 and S3 （30 patients in each group）. The patients in Group S1 received propofol with a target plasma concentration of 4.0 pg/ml; patients in Group S2 received propofol with an initial target plasma concentrations of 2.0 IJg/ml that was raised to 4.0 pg/ml 3 minutes later; patients in Group S3 received an infused scheme of 3 steps; starting from a target plasma concentration of 2.0 pg/ml that was increased stepwised by 1 pg/ml until a target plasma concentration of 4.0 pg/ml was achieved, the interval between the two steps was 3 minutes. When an Observer＇s Assessment of Alertness/Sedation （OANS） score of 1 was achieved, remifentanil （effect-site concentration （Ce） of 4.0 ng/ml） and rocuronium 0.9 mg/kg were administered. Tracheal intubation was started 2 minutes after rocuronium injection. Changes of propofol Ce, blood pressure （BP）, heart rate （HR）, and bispectral index （BIS） were recorded. Results When an OAA/S score of 1 was achieved, Ce of propofol were （1.7±0.4） pg/ml, （1.9±0.3） pg/ml, （1.9±0.4） pg/ml and the BIS values were 64±5, 65±8, and 62±8 in Groups S1, S2 and S3. Before intubation, Ce of propofol was （2.8±0.2） pg/ml, （2.8±0.3） pg/ml, （2.7±0.3） pg/ml, and the BIS values were 48±7, 51±7, and 47±5 in Groups S1, S2 and S3. By linear regression analysis, a significant correlation between Ce of propofol and BIS values was found （r=-0.580, P 〈0.01）. Systolic blood pressure （SBP） before intubation was significantly lower in Group S1 than in Groups S2 and S3. SBP and HR after intubation in the three groups were significantly increased when compared with pre-intubation values, but they did not exceed baseline values Conclusions During the TCI induction, Ce of propofol with （1.9±0.3） pg/ml may make the elderly patients unconscious. When remifentanil with a Ce of 4.0 ng/ml is added a Ce of propofol with （2.8±0.3） pg/ml is suitable for intubation. The Ce of propofol has a close correlation with the BIS values. Also, a two-step TCI technique seems to be a more suitable method of anesthesia induction in elderly patients compared with the no-stepwise TCI technique and three-step TCI technique.
文摘目的观察帕金森病(Parkinson’s disease,PD)患者与非PD患者丙泊酚诱导意识消失所需的效应室浓度(effect-site concentration,Ce)。方法纳入2022年10月16日至2023年10月14日于首都医科大学附属北京天坛医院就诊的患者,筛选年龄50~80岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅱ-Ⅲ级,行双侧脑深部电刺激手术的PD患者(PD组),并按照年龄和性别匹配选取同期行非神经外科非心脏手术的非PD患者(Non-PD组)各37例为研究对象。采用Schnider模型靶控泵注丙泊酚,警觉/镇静观察(Observer’s Assessment of Alertness/Sedation,OAA/S)评分达1分后20 s评估意识状态,采集5 min临床试验数据后停药,记录给药后OAA/S评分1分时、停药后OAA/S评分3分时丙泊酚的Ce、患者状态指数(patient state index,PSI)。结果PD患者组诱导至无意识状态所需丙泊酚剂量明显少于Non-PD患者组[(2.2±0.4)mg/L vs(3.1±0.4)mg/L,P<0.05];与Non-PD患者比较,PD患者意识消失和意识恢复时的PSI值更高(P<0.05),意识恢复时间明显延长(P<0.05),意识恢复时丙泊酚Ce更低(P<0.05)。结论PD患者诱导意识消失所需的丙泊酚剂量降低,且需要在更低的Ce下苏醒,苏醒时间明显长于非PD患者,在意识消失和苏醒时的PSI均高于非PD患者,麻醉管理中应予以重视。
