麻醉深度对晚期运动反应的特征和影响
M C Gadella1, M Sahinovic2, C H M Scholtens-Henzen3
1Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, the Netherlands; Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, the Netherlands.
概括
像F波和H反射这样的晚期运动反应在普罗波福/雷米芬坦尼尔麻醉期间可以记录. 更深的麻醉适度地影响F波,显示肌肉依赖的变异性,而H反射更一致.
科学领域:
- 神经生理学 神经生理学
- 麻醉学 麻醉学
- 在手术期间的神经生理监测 (IONM)
背景情况:
- 晚期运动反应 (F波,H反射) 评估脊髓刺激性和运动通路完整性.
- 这些响应在IONM中具有潜在价值,但不经常使用.
- 了解全身麻醉对这些反应的影响对于IONM整合至关重要.
研究的目的:
- 调查不同全身麻醉深度对F波和H反射特征的影响.
- 为了确定在propofol/remifentanil麻醉下晚期运动反应的可靠性和可变性.
- 评估这些反应在手术内神经生理学监测中的潜在有用性.
主要方法:
- 进行了普罗波福/雷米芬坦尼尔麻醉,目标是双光谱指数 (BIS) 值为30,40和50.
- 记录F波,H反射和Tc-mMEP,每隔2到4分钟进行记录.
- 线性混合效应模型被用来分析麻醉剂对记录反应的影响.
主要成果:
- 在23/25名患者中,H反射始终被引起;随着BIS的增加,幅度下降.
- 在所有患者中都引起了F波,幅度的变化取决于肌肉.
- 在特定的肌肉中,F波振幅随着BIS的增加 (吸收器幻觉,手),但在其他肌肉中没有增加 (前椎,腹肌肌). F波持久性与BIS.I显示了最小的变化.
结论:
- 晚期运动反应在普罗波福/雷米芬坦尼尔麻醉期间可靠地记录.
- F波表现出比H反射更大的可变性,可能会影响它们在某些肌肉中的使用.
- 更深的麻醉对F波产生了适度的影响,但它们仍然是IONM可以引起和解释的.
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