Journal of the Korean Association of Oral and Maxillofacial Surgeons

  • 제29권3호
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  • Pages.169-172
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  • 2003
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  • 2234-7550(pISSN)
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  • 2234-5930(eISSN)
대한구강악안면외과학회 (The Korean Association of Oral and Maxillofacial Surgeons)
권호 표지

Midazolam 진정요법 시 Bispectral index (BIS) Monitoring 효과의 평가를 위한 혈장농도, 진정지수(Sedation Score) 사이의 상관 관계 분석

RELATIONSHIP BETWEEN BISPECTRAL INDEX (BIS), SEDATION SCORE AND PLASMA CONCENTRATION FOR EVALUATION OF MONITORING EFFECT OF BISPECTRAL INDEX IN MIDAZOLAM SEDATION

  • 박은진 (서울대학교 치과대학 치과마취과학교실) ;
  • 염광원 (서울대학교 치과대학 치과마취과학교실) ;
  • 김은석 (충남대학교병원 구강악안면외과) ;
  • 김현정 (서울대학교 치과대학 치과마취과학교실)
  • Park, Eun-Jin (Dept. of Dental Anesthesiology, College of Dentistry, Seoul National University) ;
  • Yum, Kwang-Won (Dept. of Dental Anesthesiology, College of Dentistry, Seoul National University) ;
  • Kim, Eun-Seok (Dept. of Oral and Maxillofacial Surgery, Chungnam National University Hospital) ;
  • Kim, Hyun-Jeong (Dept. of Dental Anesthesiology, College of Dentistry, Seoul National University)
  • 발행 : 2003.06.30
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초록

Purpose : We examined the relationship between BIS, sedation score and plasma midazolam concentration to verify the usefulness of BIS to assess the patient's consciousness during sedation. Patients and Methods : Twenty-five young, healthy adult volunteers participated in this clinical study. Midazolam was administered intravenously up to 0.08 mg/kg to induce unconsciousness and we monitored the patient's physiological and conscious status until complete recovery from sedation. BIS and sedation score were measured before sedation, 10, 20, 30 minutes after midazolam administration. Plasma midazolam concentration was measured 10 minutes after midazolam administration. BIS was measured using A-2000 BISTM monitor (Aspect Medical Systems, USA) and the degree of sedation was evaluated with the sedation score. Results : The BIS score correlated with the sedation score (r = 0.676; P < 0.05). With the decreased plasma midazolam concentration, the correlation was better with sedation score (r = -0.656). Although BIS values did not correlate with calculated plasma concentration of midazolam (r = 0.467) at 10 minutes after midazolam administration, values after sedation were well distinguished from those before sedation. Conclusions : BIS is known for an effective predictor of patient's hypnotic state, and it is correlated with the sedation score. But, it doesn't always coincide with the clinical parameters of depth of sedation. So more attention is needed using BIS only during sedation, and it is advisable that the patient's consciousness is monitored with variable sedation score systems every several minutes.

키워드

참고문헌

  1. Tempe DK: In search of a reliable awareness monitor. Anesth Analg 2001;92:801-804.
  2. Flaishon R, Windsor A, Sigl J, Sebel PS: Recovery of consciousness after thiopental or propofol. Anesthesiology 1997;86:613-619. https://doi.org/10.1097/00000542-199703000-00013
  3. Sleigh JW, Donovan J: Comparison of bispectral index, 95% spectral edge frequency and approximate entropy of the EEG, with changes in heart rate variability during induction of general anesthesia. Br J Anaesth 1999;82:666-71. https://doi.org/10.1093/bja/82.5.666
  4. Glass PS, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P: Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanyl in healthy volunteers. Anesthesiology 1997;86:836-847. https://doi.org/10.1097/00000542-199704000-00014
  5. Doi M, Gajraj RJ, Mantzaridis H, Kenny GNC: Relationship between calculated blood concentration of propofol and electrophysiological variables during emergence from anesthesia: comparison of bispectral index, spectral edge frequency, median frequency and auditory evoked potential index. Br J Anaesth 1997;78:180-184. https://doi.org/10.1093/bja/78.2.180
  6. Billard V, Gambus PL, Chamoun N, Stanski DR, Shafer SR: A comparison of spectral edge, delta power, and bispectral index as EEG measures of alfentanil, propofol, and midazolam drug effect. Clin Pharmacol Ther 1997;61:45-58. https://doi.org/10.1016/S0009-9236(97)90181-8
  7. Stanski DR: Monitoring depth of anesthesia, Anesthesia, Third edition. New York, Churchill Livingston, 1990:1127-59.
  8. Smith WD, Dutton RC, Smith NT: Measuring the performance of anesthetic depth indicators. Anesthesiology 1996;84:38-51. https://doi.org/10.1097/00000542-199601000-00005
  9. Kearse LA, 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. https://doi.org/10.1097/00000542-199412000-00010
  10. Vernon JM, Lang E, Sebel P, Manberg PJ: Prediction of movement using BIS electroencephalographic analysis during propofol / alfentanil or isoflurane / alfentanil anesthesia. Anesth Analg 1995;80:780-5. https://doi.org/10.1097/00000539-199504000-00023
  11. Mortier E, Struys M, De Smet T, Versichelen L, Rolly G: Closed-loop controlled administration of propofol using bispectral analysis. Anaesthesia 1998;53:749-754. https://doi.org/10.1046/j.1365-2044.1998.00467.x
  12. Song D, Joshi GP, White PF: Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia. Anesthesiology 1997;87:842-8. https://doi.org/10.1097/00000542-199710000-00018
  13. Song D, Vlymen JV, White PF: Is the bispectral index useful in predicting fast-track eligibility after ambulatory anesthesia with propofol and desflurane? Anesth Analg 1998;87:1245-8.
  14. Hall JD, Lockwood GG: Bispectral index: comparison of two montages. Br J Anaesth 1998;80:342-4. https://doi.org/10.1093/bja/80.3.342
  15. Sebel PS, Bowles SM, Saini V, Chamoun N: EEG bispectrum predicts movement during thiopentone / isoflurane anesthesia. J Clin Monitoring 1995;11:83-91. https://doi.org/10.1007/BF01617729
  16. Prys-Roberts C: Anesthesia: A practical or impractical construct? Br J Anaesth 1987;59:1341-5.
  17. Kissin I: General anesthetic action: An obsolete notion? Anesth Analg 1993;76:215-218.