在全身麻醉期间预测的普罗波福度和测量的度的变化:单中心回顾性队列研究
Thomas W Schnider1, Charles F Minto2
1Department of Anaesthesia, Intensive Care, Emergency and Pain Medicine, Kantonsspital St. Gallen, Switzerland.
麻醉药物定位的变化率很高. 在麻醉期间准双光谱指数 (BIS) 时,sevoflurane和propofol度显示出相似的变化,这表明药理动力学模型的改进不太可能减少这种变化.
科学领域:
- 麻醉学 麻醉学
- 药理动力学 药理动力学
- 临床麻醉 临床麻醉
背景情况:
- 在目标控制输注 (TCI) 麻醉期间预测的普罗波福度存在很高的变化,目的是保持特定的双光谱指数 (BIS).
- 药物动力学模型显示,在预测麻醉药物度方面,改善的潜力很小.
- "药物定位悖论"强调了麻醉期间剂量效果关系的挑战,表明动态的外科因素影响了超出静态患者特征的必要药物剂量.
研究的目的:
- 为了比较测量到的潮末塞沃氨酸度的变异性与在BIS导向麻醉期间预测到的效果部位度.
- 为了测试sevoflurane度变化不低于propofol度变化的假设.
主要方法:
- 分析了2280次超过1小时的外科手术的临床数据.
- 使用sevoflurane或propofol TCI根据机构协议进行麻醉.
- 皮肤切口30分钟后比较BIS值,以评估标位性能,并计算/比较两种药物的度变化.
主要成果:
- 在切口后30分钟实现的BIS范围之间没有显著差异,sevoflurane (30 [99% CI: 28-33]) 和propofol TCI (31 [99% CI: 27-36]).
- 赛沃氨酸度的可变性与预测的普罗波度没有显著差异 (正常化度范围为0.89 [99% CI:0.78-0.99]与0.93 [99% CI:0.87-1.02]).
结论:
- 提高药理动力学模型的预测准确度超出当前的临床标准,不太可能降低患者中目标麻醉剂度的变化.
- 手术期间的动态因素对麻醉药物需求的变化有显著的贡献.
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