BIS监测的临床意义与新进展.ppt

* * * Isn’t anesthesiology an art and a science? * 其中提到了肌松药的问题。目前在国外关注术中知晓问题时，十分注重减少肌松药的使用，如果可能甚至不用。基于的要点是MAC和MACawake的曲线是不相交的。即，100%的患者都可以体动的七氟烷浓度下，100%的患者都睡着的（如图）。但是肌松药的使用会掩盖这个“优势”。 * One key study also measured recovery outcomes resulting from titration of anesthetic into the BIS? target range. In this study of 300 patients, BIS-guided patients emerged and were extubated more quickly after their anesthetic. In addition, PACU nurses – blinded to the anesthesia monitoring randomization – gave better recovery scores (such as: excellent recovery, fully oriented on arrival) for patients admitted to the PACU. * * This trend chart shows an occasion where increases in the BIS value correlate to increases in heart rate and blood pressure. If everything is constant (vaporizer settings, surgical stimulation etc.) this would appear to be a case of light analgesia. This incident could be a result of inadequate analgesia or may be a result of the initial dose of narcotic “wearing off”. This trend line is also a good example of a patient that requires additional analgesia. There is significant variability in the trend line, punctuated by breakthrough pain. * * Here we see a patient whose BP and HR are increasing but the BIS value has remained very steady. Without the benefit of BIS monitoring, most providers would choose to treat this by either increasing the agent flows and/or giving more narcotic. This situation appears to be hypertension and not light analgesia. It would be more appropriate to treat the pressure as opposed to deepening the anaesthetic. * * And finally, we see a patient who, in spite of fairly light end-tidal agent concentrations, is hypotensive. With the ability to directly monitor the patients level of consciousness, the anaesthesia provider can safely reduce their % of agent and support both the HR and BP. * * 当BIS监护仪用于麻醉监护，对BIS值波动的起伏是有必要注意的。然而，像血压这样单独的波动，是无明显意义的。但是，在一些情况，例如预料外、突然的改变，附加的评估和确认是必需的。 这幅图显示了BIS的趋势。描述了BIS趋势中突然的变化，这可能预示意外的觉醒反映。因为BIS