점막하 Midazolam의 병용투여 시 BIS 분석을 이용한 진정 평가

이영은,박미경,김소영,김윤희,정상혁,백광우 대한소아치과학회 2007 大韓小兒齒科學會誌 Vol.34 No.1

Chloral hydrate(CH)와 Hydroxyzine의 경구 복용을 이용한 진정과 Midazolam을 점막하 주사로 추가 투여한 진정을 Bispectral(BIS) index를 이용하여 두 진정법의 진정 깊이의 차이를 비교 평가하고자 하였다. 모든 환아는 2세-6세 사이의 미국 마취과학회 신체평가 등급 I의 건강한 환아로 진정 요법이 요구되었으며 국소마취와 최소 2개 이상의 치아에 대한 수복 치료가 치료에 포함되었다. 무작위 방법으로 환아를 CH(60mg/kg)와 Hydroxyzine(1mg/kg)을 복용하는 군과 CH(60mg/kg)와 Hydroxyzine(1mg/kg)을 복용하고 점막하 주사로 Midazolam(0.1mg/kg)을 추가 투여하는 군으로 나누었다. 진정 요법 동안 Nitrous Oxide는 두 군 모두 50%로 유지 하였다. 환아 행동 평가는 녹화된 비디오 테이프를 보며 매 2분마다 Behavior scale을 이용하여 quiet(Q), crying(C), movement(M), or struggling(S)으로 측정하였다. 두 군의 진정 깊이 비교 평가를 위해 치료가 시작된 시점부터 40분 동안 2분 간격으로 측정 한 Pulse rate(PR), Saturation percentage of 0_(2)(SpO_(2)), brhavior scale과 매 2분 단위로 계산된 평균 BIS index를 t-test와 Levene's test를 이용하여 분석하였다. 두 군의 평균 BIS index와 BIS index의 분포는 유의할 만한 차이를 보였다(P<0.001). 점막하 주사로 Midazolam을 추가 투여한 군에서 평균 BIS index가 더 낮은 값을 가지며 표준 편차가 작았다. PR와 SpO_(2)는 두 그룹 모두 정상 범위내의 값을 보였다. 점막하 주사를 이용한 Midazolam의 추가 투여는 안전성을 크게 침해하지 않는 범위 내에서 진정 깊이를 깊게 해주며 안정적인 진정을 이루게 함으로써 보다 바람직한 진정을 유도해 줄 수 있는 것으로 사료된다. The aim of this study was to examine the difference of the depth of sedation using the Bispectral index assessment with and without the added submucosal Midazolam to oral Chloral hydrate and Hydroxyzine for pediatric patients. Twenty seven sedation cases were performed in this study. Selection criteria included good health(ASA I), 2 to 6 years of age, the need for sedation to receive dental treatment including anesthesia, and restorative procedure over at least two teeth. Patients were randomly classified into one group taking oral Chloral hydrate(60 mg/kg) and Hydroxyzine(1 mg/kg) and the other group recieving Chloral hydrate(60 mg/kg), Hydroxyzine(1 mg/kg) and submucosal Midazolam(0.1 mg/kg). Nitrous Oxide(50%) was used for both group during sedation. Patients were monitored using a pulse oximeter and a Bispectral monitor. A behavior scale was rated as quiet(Q), crying(C), movement(M), or struggling(S) every 2 minutes watching a recorded videotape. Analysis showed a significant difference in mean Bispectral index and SD during sedation across two groups(P<0.001). The group of patients injected with submucosal Midazolam in addition to oral Chloral hydrate and Hydroxyzine showed a lower mean Bispectral index and a narrower SD. PR and Sp02 for both groups remained within the normal values. Submucosal Midazolam improved the sedation quality by deepening sedation depth without compromising safety and enabled the sedation pattern to be kept more stable.

임상연구 : Sevoflurane 마취 시 아산화질소가 Bispectral Index에 미치는 영향

김경헌 ( Kyoung Hun Kim ),최윤정 ( Yun Jeong Choi ),심재항 ( Jae Hang Shim ),전우재 ( Woo Jae Jeon ),조상윤 ( Sang Yoon Cho ),신우종 ( Woo Jong Shin ),염종훈 ( Jong Hoon Yeom ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5

Background: Nitrous oxide is generally avoided in order to prevent either hypoxia or graft dislodgment during tympanoplasty. The aim of this study was to investigate the effect of nitrous oxide on the bispectral index during sevoflurane anesthesia at the anesthetic dose. Methods: The bispectral index was continually measured during nitrous oxide-oxygen-sevoflurane anesthesia, discontinuation of nitrous oxide and the reintroduction of nitrous oxide. Results: The bispectral index of nitrous oxide-oxygen-sevoflurane anesthesia increased after discontinuing the nitrous oxide and decreased after its reintroduction. Conclusions: Nitrous oxide decreased the bispectral index of nitrous oxide-oxygen-sevoflurane anesthesia compared with oxygen-sevoflurane anesthesia at the anesthetic dose. (Korean J Anesthesiol 2006; 50: 511~4)

임상연구 : Propofol 마취 시 근이완제의 투여가 Bispectral Index에 미치는 영향

이신영 ( Shin Young Lee ),신혜원 ( Hye Won Shin ),이혜원 ( Hye Won Lee ),윤석민 ( Suk Min Yoon ),장성호 ( Seong Ho Chang ),임혜자 ( Hae Ja Lim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6

Background: There have been some conflicting reports showing that the muscle relaxant affect the level of bispectral index (BIS) during various condition of anesthesia. The purpose of this study was to investigate whether muscle relaxant affects the level of BIS during propofol anesthesia. Methods: Eighty patients (ASA class I or II, 20-55 yrs) scheduled for elective surgery under general anesthesia were randomly assigned to four groups. Anesthesia was maintanined at a BIS level of 60 by propofol target controlled infusion (TCI) with air-oxygen (2 L/min:2 L/min). After maintaining BIS 60 with spontaneous breathing, normal saline 0.05 mg/kg was iv injected in group I and vecuronium bromide 0.1 mg/kg was iv injected in group II. After maintaining at a BIS level of 40 with assisted ventilation, normal saline 0.05 mg/kg was iv injected in group III and vecuronium bromide 0.1 mg/kg was iv injected in group IV. The BIS, mean arterial pressure, and heart rate were measured before anesthetic induction and up to 10 min after normal saline or vecuronium bromide injection in each group. Results: BIS was not changed in group I, but BIS significantly decreased in group II (P < 0.05). In group III and IV, BIS were not changed in both group. There were no hemodynamic changes among the four groups. Conclusions: These result suggest that the effect of muscle relaxant on BIS vary according to the level of BIS during propofol anesthesia. (Korean J Anesthesiol 2006; 50: 611~5)

전신마취하 관절경 무릎 수술 시 지혈대 감압이 Bispectral Index에 미치는 영향

최정현 ( Jeong Hyun Choi ),성준경 ( Joon Kyung Sung ),박성욱 ( Sung Wook Park ),강화자 ( Wha Ja Kang ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4

Background: Tourniquet deflation during lower extremity surgery affects the hemodynamics and metabolism of the patient, which can affect brain activity. This study examined the changes in brain activity during tourniquet deflation by measuring the bispectral index (BIS). Methods: The BIS was measured during surgery in forty patients who had received knee arthroscopic surgery under general anaesthesia. The BIS was measured 5 minutes before deflation (DB5) and 5 minutes after deflation (DA5). Results: The BIS at DB5 and DA5 was 50.2±9.9 and 44.4±10.4, respectively. The BIS of DA5 was significantly lower than that of DB5 (P<0.05). Conclusions: Tourniquet deflation during lower extremity surgery decreases the BIS associated with hemodynamic and metabolic changes. However, its clinical significance in neurologically critical patients, such as geriatric or neurologically disabled patients, remains to be clarified. (Korean J Anesthesiol 2009;56:371~4)

증례보고 : 근긴장성 이양증 환자에서 질식 자궁근종절제술 시 Bispectral Index를 이용한 전정맥마취

이해진 ( Hae Jin Lee ),전진영 ( Jin Young Chon ),황수진 ( Su Jin Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2

We report a patient with myotonic dystrophy, who underwent a transvaginal uterine myomectomy. Anaesthesia was induced and maintained with remifentanil and the target-controlled infusion of propofol titrated according to the bispectral index (BIS). A ProSeal laryngeal mask airway (PLMA) was inserted, and mechanical ventilation was performed without a muscle relaxant. The time from the end of anaesthesia to the patient-awakening was approximately 8 minutes. The rapid offset of the action of remifentanil and low-dose propofol facilitated early recovery without respiratory complications. The total intravenous anaesthesia using the BIS and the PLMA without a muscle relaxant is a useful anaesthetic technique in myotonic dystrophy patients. (Korean J Anesthesiol 2007; 53: 238~41)

임상연구 : 의식 있는 중환자실 환자에서 기관 내 흡인 시 Propofol과 Fentanyl의 정맥 내 투여가 Bispectral Index에 미치는 영향

이재익 ( Jae Ik Lee ),전종헌 ( Jong Hun Jun ),김교상 ( Kyo Sang Kim ),서정국 ( Jung Kook Suh ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2

Background: We performed a prospective, randomized, and controlled trial to evaluate the effect of an intravenous fentanyl and propofol on the variation in BIS level associated tracheal suction. Methods: Thirty ICU patients intubated or tracheostomized were randomly allocated to control and experimental groups. Control group was received saline and experimental groups were received propofol with or without fentanyl intravenously prior to tracheal suction. And then we monitored BIS index, blood pressure, heart rate and SpO2 before, during and after tracheal suction. Results: BIS index was significantly lower in propofol plus fentanyl group than others during experiment (P < 0.05). Heart rate and blood pressure in propofol plus fentanyl group also less increased than those in control or propofol group during tracheal suction (P < 0.05). Conclusions: These results suggest that co-administration of propofol and fentanyl has more effective than propofol alone in sedation and analgesia of ICU patients during tracheal suction. (Korean J Anesthesiol 2007; 52: 156~60)

소아에서 Sevoflurane 마취 시 Bispectral Index와 Spectral Entropy의 비교

최소론,정찬종,박상원,이수일 대한마취통증의학회 2009 Anesthesia and pain medicine Vol.4 No.2

Background: Bispectral index (BIS) is a useful tool to assess depth of anesthesia. Recently, spectral entropy has been promoted as a monitor of anesthetic depth in adult, but its characteristics in children remains poorly defined. This study was to compare BIS and entropy indices during sevoflurane anesthesia in children. Methods: Forty children (aged 1−12 yr) scheduled for ENT surgery, were included. Anesthesia was induced with 5.0% sevoflurane in O2 6 L/min. Tracheal intubation was performed with rocuronium 0.6 mg/kg. Heart rate, blood pressure, end-tidal sevoflurane concentration (Etsev), BIS, response entropy (RE) and state entropy (SE) were measured every 5 minutes. The correlation between BIS and entropy index and Etsev was calculated, Results: The BIS, SE and RE values decreased with induction and increased with recovery. The BIS, RE, and SE values were inversely proportionally related to the Etsev. The RE and SE values were closely correlated with the BIS values (respectively r = 0.948 and r = 0.946, P < 0.001). Conclusions: We demonstrated a close correlation of SE and RE with Etsev and with BIS during sevoflurane anesthesia in children. State entropy and RE seem to be useful electroencephalographic measures of sevoflurane drug effect in children.

임상연구 : Propofol을 이용한 완전 정맥 마취에서 기관내 삽관 시 Remifentanil이 Bispectral Index에 미치는 영향

이준호 ( Joon Ho Lee ),김순임 ( Soon Im Kim ),김문규 ( Mun Gyu Kim ),김선종 ( Sun Chong Kim ),옥시영 ( Si Young Ok ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6

Background: The present study was undertaken to determine the effect of remifentanil on the bispectral index (BIS) during intubation under TIVA (total intravenous anesthesia) using propofol. Methods: In this prospective, randomized, double-blind study, 80 healthy patients aged 18-60 years undergoing elective surgery were investigated. Anesthesia was induced using propofol (target effect-site concentration 4μg/ml). After the loss of consciousness, rocuronium (0.9 mg/kg) and remifentanil was infused. The patients in the R group were infused with remifentanil using a target effect-site concentration of 4μg/ml, and patients in the P group were infused with saline. The BIS value, mean arterial pressure (MAP) and heart rate (HR) were measured before induction, before remifentanil infusion and before and after tracheal intubation. Results: The BIS value remained constant after intubation in the two groups. The MAP and HR increased significantly after intubation in the two groups, but the degree of increase of MAP and HR was less in group R than in group P significantly. Conclusions: We suggest that the BIS value is not affected by the administration of remifentanil during intubation under TIVA using propofol. (Korean J Anesthesiol 2007; 53: 695∼9)

Propofol과 Remifentanil을 이용한 정맥마취 중 Butorphanol이 Bispectral Index에 미치는 영향

정규돈 대한마취통증의학회 2007 Anesthesia and pain medicine Vol.2 No.4

Background: The aim of this study was to investigate the effect of butorphanol on the Bispectral Index (BIS) during the administration of intravenous anesthesia with propofol and remifentanil. Methods: Forty adult patients, ASA I-II, scheduled for an emergency laparoscopic appendectomy were studied. The doses for the anesthetics were adjusted to keep the BIS value between 40 and 50. After 20 minutes of stable anesthesia, the subjects were randomly allocated to receive intravenous saline (control group) or 0.02 mg/kg butorphanol (butorphanol group). The BIS values, mean arterial pressure, and heart ratewere recorded every five minutes for a period of 20 minutes. Results: The mean BIS values after butorphanol administration were not significantly different from the values following the administration of saline, throughout the observation period. No patients were able to recall explicitly any events under anesthesia. No significant changes in mean arterial pressure and heart rate were noted after butorphanol administration. Conclusions: Butorphanol given to prevent postoperative pain does not modify the BIS value during anesthesia maintained with remifentanil and propofol.

임상연구 : 제왕절개술 초기 Bispectral Index를 이용한 Thiopental과 Propofol의 재평가

이해진 ( Hae Jin Lee ),전진영 ( Jin Young Chon ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1

Background: Patients undergoing a cesarean section are at risk of experiencing intra-operative awareness. Thiopental and propofol are both commonly used to induce anesthesia in patients undergoing a cesarean section. This study compared the effect of propofol and thiopental on the anesthetic adequacy of parturients who received inhalation anesthetics using the bispectral index (BIS) in the early period of a cesarean section. Methods: Forty-five parturients were randomly assigned to receive either thiopental 4 mg/kg or propofol 2 mg/kg followed by 1% isoflurane with 50% N2O. The BIS, systolic and diastolic arterial pressure, heart rate, and the end-tidal concentration of isoflurane were recorded every minute for 10 minutes after intubation. The apgar score at 1 and 5 minutes and cord blood gas were assessed. Results: The systolic and diastolic pressure immediately after intubation were significantly lower in the Propofol group than in the Thiopental group. All the BIS values from 0 to 9 minutes after intubation were significantly lower in the Propofol group than in the Thiopental group. The Apgar scores and umbilical cord blood gas analysis were similar both groups. Conclusions: These results suggest that propofol is more suitable for the anesthetic adequacy and intraoperative awareness in the early period of a cesarean section than thiopental. (Korean J Anesthesiol 2007; 52: 49~54)