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七氟醚麻醉期间连续输注不同剂量艾司氯胺酮对脑电双频指数的影响：随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：王璐 编辑：杨荣峰 审校：曹莹
研究并量化七氟醚麻醉期间连续输注不同剂量的艾司氯胺酮对脑电双频指数（BIS）的影响。
将120例择期行腹腔镜肾脏手术的患者随机分为三组。在稳定的麻醉和手术情况下，患者开始连续输注研究药物：0.125mg/kg/h艾司氯胺酮（E1组）、0.25mg/kg/h艾氯胺酮（E2组）和相同体积的生理盐水（ C组）。主要指标是药物输注15分钟（T 15 ）、30分钟（T 30 ）、45分钟（T 45 ）和60分钟（T 60 ）后BIS值的变化。次要指标是从 T 0到 T 60的 95% 频谱边缘频率 (SEF95)、肌电图 (EMG)、心率 (HR) 和平均动脉压 (MAP)。此外，还评估了术后疼痛、术后恢复和围手术期不良事件。
与C组相比，E1组在T 30 ~T 60时BIS显著升高，E2组在T 15 ~T 60时BIS显著升高（ P < 0.001）。与E1组相比，E2组在T 15 –T 60时BIS升高更为显著（ P < 0.001）。E2 组 BIS 和 SEF95 曲线下面积（AUC）显著高于 C 组和 E1 组（ P < 0.05）。三组中任意一组的 BIS 值与 SEF95 显著相关（ P < 0.001）。在三个组别中，肌肉电图(EMG)、心率(HR)和平均动脉压(MAP)的曲线下面积(AUC)没有显著差异。E2 组术中瑞芬太尼用量及术后运动疼痛 NRS 均较 C、E1 组显著降低（ P < 0.05）。
七氟醚麻醉过程中连续输注0.125和0.25 mg/kg/h艾司氯胺酮均使BIS值升高,且随着输注时间的延长BIS值逐渐稳定。
原始文献来源：Ren L,Yang J,Li Y, et al. Effect of Continuous Infusion of Different Doses of Esketamine on the Bispectral Index During Sevoflurane Anesthesia: A Randomized Controlled Trial. Drug Des Devel Ther. 2024;18:1727-1741. doi:10.2147/DDDT.S457625
Effect of Continuous Infusion of Different Doses of Esketamine on the Bispectral Index During Sevoflurane Anesthesia: A Randomized Controlled Trial
Purpose: To investigate and quantify the effect of continuous esketamine infusion at different doses on the bispectral index (BIS) during sevoflurane anesthesia.
Methods: A total of 120 patients scheduled for elective laparoscopic renal surgery were randomly divided into three groups. Under steady anesthesia and surgical situations, the patient was started on continuous infusion of the study drug: 0.125 mg/kg/h esketamine (group E1), 0.25 mg/kg/h esketamine (group E2), and the same volume of saline (group C). The primary outcome was changes in BIS value after 15 min (T15), 30 min (T30), 45 min (T45), and 60 min (T60) of drug infusion. The secondary outcomes were 95% spectral edge frequency (SEF95), electromyogram (EMG), heart rate (HR), and mean arterial pressure (MAP) from T0 to T60. Furthermore, postoperative pain, postoperative recovery, and perioperative adverse events were evaluated.
Results: Compared with group C, group E1 exhibited significant BIS elevation at T30–T60 and group E2 at T15–T60 (P < 0.001). Compared with group E1, group E2 showed a more significant BIS elevation at T15–T60 (P < 0.001). The area under the curve (AUC) of BIS and SEF95 were significantly higher in group E2 than in groups C and E1 (P < 0.05). BIS value for any of the three groups was significantly correlated with SEF95 (P < 0.001). No significant differences were observed in the AUC of EMG, HR, and MAP among the three groups. Intraoperative remifentanil consumption and postoperative NRS of pain on movement were significantly reduced in group E2 compared with groups C and E1 (P < 0.05).
Conclusion: Continuous infusion of both 0.125 and 0.25 mg/kg/h of esketamine increased the BIS value during sevoflurane anesthesia, and the BIS value gradually stabilized with the prolongation of the infusion time.
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