Abstract
Purpose
To observe the changes in EEG bispectral index (BIS), 95% spectral edge frequency (95% SEF) and median frequency (MF) with haemodynamic changes to intubation during induction with propofol or propofol and 2 μg· kg−1 fentanyliv.
Methods
Twenty four ASA 1–11 patients were randomized to receive either propofol infusion preceded by normal saline (group P, n= 12) or propofol preceded by 2 μg· kg−1 fentanyl (group PF, n= 12). Intubation was performed five minutes after maintenance of BIS within 45 ± 5. EEG and haemodynamic variables were recorded at before induction, and before and after intubation.
Results
Haemodynamic responses to intubation were greater in group P than in group PF (P < 0.05). Postintubation SBP, DBP and HR increased, compared with preinduction values, more in group P than in group PF Postintubation BIS values increased from 45.5 ± 3.5 and 44.2 ± 4.1 to 51.1 ± 4.1 and 50.9 ± 5.3 in groups P and PF, respectively, compared with preintubation values. The BIS values were not different between treatment groups before and after intubation, and 95% SEF and MF values did not increase after intubation.
Conclusion
Fentanyl, 2 μg· kg−1 iv, blunted the haemodynamic responses to intubation, but failed to attenuate the arousal of cerebral cortical activity. The different haemodynamic responses postintubation but similar BIS and 95% SEF changes in the two groups suggest that BIS or 95% SEF cannot predict the haemodynamic responses to intubation during anaesthesia induction with propofol and fentanyl.
Résumé
Objectif
Observer les altérations de l’index ÉEG bispectral (BIS), sur la fréquence spectrale de marge (95% SEF) et la fréquence moyenne (FM) causées par les changements hémodynamiques de l’intubation pendant l’induction au propofol ou au propofol associé au fentanyl 2 μg· kg−1 iv.
Méthodes
Vingt-quatre patients ASA 1–11 ont reçu aléatoirement soit une perfusion de propofol précédée de sol. phys. (groupe P, n = 12) ou de propofol précédé de fentanyl 2 μg· kg−1 (groupe PF, n = 12). On intubait cinq minutes après la stabilisation du BIS entre 45 ± 5. L’ÉEg et les variables hémodynamiques étaient enregistrées avant l’induction, et avant et après l’intubation.
Résultats
Les réponses hémodynamiques à l’intubation étaient plus importantes dans le groupe P que dans le groupe PF (P< 0,05). Après l’intubation, la pression artérielle systolique et diastolique et la Fc augmentaient comparativement aux valeurs de préinduction, mais plus dans le groupe P que dans le groupe PF Après l’intubation, les valeurs du BIS augmentaient de 45 ± 3,5 à 51 ± 4.1 dans le groupe P et de 44 ± 4,1 à 50,9 ± 5,3 dans les groupes PF comparativement aux valeurs précédant l’intubation ; les valeurs SEF 95% et MF n’augmentaient pas après l’extubation.
Conclusion
Le fentanyl 2 μg· kg−1 iv atténue les réponses hémodynamiques à l’intubation mais ne parvient pas à atténuer l’éveil de l’activité corticale cérébrale. La différence des réponses hémodynamiques postintubation mais la similarité des changements de BIS et de SEF95% dans les deux groupes suggèrent que BIS et SEF 95% ne peuvent prédire les réponses hémodynamique à l’intubation pendant l’induction de l’anesthésie au propofol et au fentanyl.
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References
Kearse LA Jr, Manberg P, Chamoun N, Debros F, Zaslavsky A. Bispectral analysis of the electroencephalogram correlates with patient movement to skin incision during propofol/nitrous oxide anesthesia. Anesthesiology 1994; 81: 1365–70.
Vernon JM, Lang E, Sebel PS, Manberg P. Prediction of movement using bispectral electroencephalographic analysis during propofol/alfentanil or isoflurane alfentanil anesthesia. Anesth Analg 1995; 80: 780–5.
Leslie K, Sessler DI, Schroeder M, Walters K. Propofol blood concentration and the bispectral index predict suppression of learning during propofol/epidural anesthesia in volunteers. Anesth Analg 1995; 81: 1269–74.
Doi M, Gajraj RJ, Mantzaridis H, Kenny GNC. Relationship between calculated blood concentration of propofol and electrophysiological variables during emergence from anaesthesia: comparison of bispectral index, spectral edge frequency, median frequency and auditory evoked potential index. Br J Anaesth 1997; 78: 180–4.
Liu J, Singh H, White PF. Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg 1997; 84: 185–9.
Billard V, Moulla F, Bourgain JL, Megnigbeto A, Stanski DR. Hemodynamic response to induction and intubation. Propofol/fentanyl interaction. Anesthesiology 1994; 81: 1384–93.
Widdicombe JG. Receptors in the trachea and bronchi of the cat. J Physiol (Lond) 1954; 123: 71–104.
Boushey HA, Richardson PS, Widdicombe JG, Wise JCM. The response of laryngeal afferent fibres to mechanical and chemical stimuli. J Physiol (Lond) 1974; 240:153–75.
Kearse LA Jr, Manberg P, DeBros F, Chamoun N, Sinai V. Bispectral analysis of the electroencephalogram during induction of anesthesia may predict hemodynamic responses to laryngoscopy and intubation. Electroenceph Clin Neurophysiol 1994; 90: 194–200.
Rampil IJ, Matteo RS. Changes in EEG spectral edge frequency correlate with the hemodynamic response to laryngoscopy and intubation. Anesthesiology 1987; 67: 139–42.
Lui PW, Wang H, Kearse LA. The bispectral index does not predict hemodynamic responses to laryngoscopy and intubation during propofol-inducted EEG burst suppression. Anesthesiology 1996; 85: A175.
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Mi, WD., Sakai, T., Takahashi, S. et al. Haemodynamic and electroencephalograph responses to intubation during induction with propofol or propofol/fentanyl. Can J Anaesth 45, 19–22 (1998). https://doi.org/10.1007/BF03011986
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DOI: https://doi.org/10.1007/BF03011986