Hu Jing,Hua Lei,Huo Lianghong,et al.Analysis of influencing factors of adequate anesthesia time ratio of closed-loop infusion of propofol in children[J].Journal of Clinical Pediatric Surgery,,20():458-463.[doi:10.12260/lcxewkzz.2021.05.012]
Analysis of influencing factors of adequate anesthesia time ratio of closed-loop infusion of propofol in children
- CLC:
- R726;R614
- Abstract:
- Objective To explore the influencing factors of adequate anesthesia time ratio (BIS40-60%) during CL-TCI infusion and adopt more rigorous monitoring for children with possible low BIS40-60%.Methods American Society of Anesthesiologists physical status Ⅰ~Ⅳ children (12-36 months,male=female=38;37-216 months,male=female=38) undergoing elective non-craniocerebral general anesthesia were included.Propofol was delivered through a closed-loop anesthesia delivery system.The target bispectral index (BIS) value was set at 50 during maintenance anesthesia.BIS40-60%,gender,body temperature,age,BMI,ASA grading,anesthesia duration and blood loss were recorded.Results Both ASA grade and age affected BIS 40-60% and the impact of ASA grade was more obvious.The regression equation was 71.72+0.15*month-6.82*ASA,R2=0.53.And 17 month was the age split value in month age decision tree.Conclusion As for propofol CL-TCI technology,preoperative ASA grade and young age are the risk factors leading to a 40-60% reduction in BIS and ASA grade has a greater impact on the stability of the system.For ASA Ⅲ magnitude or age 17 months or under,children should be closely observed for intraoperative sedation depth and regulation.
References:
1 Pasin L,Nardelli P,Pintaudi M,et al.Closed-loop delivery systems versus manually controlled administration of total IV anesthesia:A Meta-analysis of randomized clinical trials[J].Anesth Analg,2017,124(2):456-464.DOI:10.1213/ANE.0000000000001394.
2 Besch G,Vettoretti L,Claveau M,et al.Early post-operative cognitive dysfunction after closed-loop versus manual target controlled-infusion of propofol and remifentanil in patients undergoing elective major non-cardiac surgery:Protocol of the randomized controlled single-blind POCD-ELA trial[J].Medicine (Baltimore),2018,97(40):e12558.DOI:10.1097/MD.0000000000012558.
3 West N,van Heusden K,G?rges M,et al.Design and evaluation of a closed-loop anesthesia system with robust control and safety system[J].Anesth Analg,2018,127(4):883-894.DOI:10.1213/ANE.0000000000002663.
4 Ramos-Luengo A,Asensio-Merino F.Hypnosis closed loop TCI systems in outpatient surgery[J].Rev Esp Anestesiol Reanim,2017,64(6):323-327.DOI:10.1016/j.redar.2016.10.005.
5 胡璟,王芳,张建敏,等.丙泊酚闭环靶控输注麻醉用于学龄前及学龄患者体表手术的效果[J].中华麻醉学杂志,2017,37(7):800-803.DOI:10.3760/cma.j.issn.0254-1416.2017.07.009. Hu J,Wang F,Zhang JM,et al.Efficacy of closed-loop infusion of propofol for surgery on body surface in preschool and school-age children[J].Chin J Anesthesiol,2017,37(7):800-803.DOI:10.3760/cma.j.issn.0254-1416.2017.07.009.
6 薛辛东,李永柏.儿科学[M].北京:人民卫生出版社,2002. Xue XD,Li YB.Pediatrics[M].Beijing:People’s Medical Publishing House,2002.
7 Sammartino M,Volpe B,Sbaraglia F,et al.Capnography and the bispectral index-their role in pediatric sedation:a brief review[J].Int J Pediatr,2010,2010:828347.DOI:10.1155/2010/828347.
8 李立晶,张建敏,胡璟,等.麻醉意识深度指数在儿童射频消融术中应用的临床研究[J].临床小儿外科杂志,2020,19(6):528-533.DOI:10.3969/j.issn.1671-6353.2020.06.013. Li LJ,Zhang JM,Hu J,et al.Clinical application of cerebral state index during radiofrequency ablation in children[J].J Clin Ped Sur,2020,19(6):528-533.DOI:10.3969/j.issn.1671-6353.2020.06.013.
9 Morgan LG,Ngai L,Eric B,et al.Automated sedation outperforms manual administration of propofol and remifentanil in critically ill patients with deep sedation:a randomized phase Ⅱ trial[J].Intensive Care Med,2013,39(3):454-462.DOI:10.1007/s00134-012-2762-2.
10 Brodie SM,G?rges M,Ansermino JK,et al.closed-loop control of total intravenous anesthesia during significant intraoperative blood loss:a case report[J].case Rep,2017,15(8):239-243.DOI:10.1213/XAA.0000000000000576.
11 Wang XH,Zhang JF,Feng KP,et al.The effect of hypothermia during cardiopulmonary bypass on three electro-encephalographic indices assessing analgesia and hypnosis during anesthesia:consciousness index,nociception index,and bispectral index[J].Perfusion,2020,35(2):154-162.DOI:10.1177/0267659119864821.
12 Dong D,Peng XM,Liu J,et al.Morbid obesity alters both pharmacokinetics and pharmacodynamics of propofol:dosing recommendation for anesthesia induction[J].Drug Metab Dispos,2016,44(10):1579-1583.DOI:10.1124/dmd.116.071605.
13 Campos S,Monteiro J,Valenzuela B,et al.Evidence of different propofol pharmacokinetics under short and prolonged infusion times in rabbits[J].Basic Clin Pharmacol Toxicol,2016,118(6):421-431.DOI:10.1111/bcpt.12521.
14 Tirel O,Wodey E,Harris R,et al.Variation of bispectral index under TIVA with propofol in a paediatric population[J].Br J Anaesth,2008,100(1):82-87.DOI:10.1093/bja/aem339.
15 Morse J,Hannam JA,Cortinez LI,et al.A manual propofol infusion regimen for neonates and infants[J].Paediatr Anaesth,2019,29(9):907-914.DOI:10.1111/pan.13706.
16 Ji SH,Lee JH,Cho JY,et al.External validation of a pharmacokinetic model of propofol for target-controlled infusion in children under two years old[J].J Korean Med Sci,2020,35(11):e70.DOI:10.3346/jkms.2020.35.e70.
17 Jeleazcov C,Ihmsen H,Schmidt J,et al.Pharmacodynamic modelling of the bispectral index response to propofol-based anaesthesia during general surgery in children[J].Br J Anaesth,2008,100(4):509-516.DOI:10.1093/bja/aem408.
18 Adelaida L,Jesús LH,Luis S,et al.Bispectral index and middle latency auditory evoked potentials in children younger than two-years-old[J].Anesth Analg,2008,106(2):426-432.DOI:10.1213/ane.0b013e3181602be1.
19 朱青青,岳维,姜敬,等.影响丙泊酚敏感性的因素的研究现状[J].中国临床药理学杂志,2020,36(7):883-886.DOI:10.13699/j.cnki.1001-6821.2020.07.045. Zhu QQ,Yue W,Jiang J,et al.Research status of influencing factors of the sensitivity of propofol[J].Chin J Clin Pharmacol,2020,36(7):883-886.DOI:10.13699/j.cnki.1001-6821.2020.07.045.
20 Johnson KB,Egan TD,Kern SE,et al.The influence of hemorrhagic shock on propofol:a pharmacokinetic and pharmacodynamic analysis[J].Anesthesiology,2003,99(2):409-420.DOI:10.1097/00000542-200308000-00023.
21 Egan ED,Johnson KB.The influence of hemorrhagic shock on the disposition and effects of intravenous anesthetics:a narrative review[J].Anesth Analg,2020,130(5):1320-1330.DOI:10.1213/ANE.0000000000004654.
Memo
收稿日期:2020-10-24。
基金项目:吴阶平医学基金会临床科研专项资助基金(编号:320.6750.19089-102)
通讯作者:张建敏:Email:zjm428@sina.com