Neuromuscular Block Differentially Affects Immobility and Cortical Activation at Near-Minimum Alveolar Concentration Anesthesia

被引:11
作者
Doufas, Anthony G. [1 ,7 ]
Komatsu, Ryu [2 ,3 ]
Orhan-Sungur, Mukadder [2 ,3 ]
Sengupta, Papiya [2 ,3 ]
Wadhwa, Anupama [2 ,3 ]
Mascha, Edward [4 ,5 ]
Shafer, Steven L. [6 ]
Sessler, Daniel I. [5 ]
机构
[1] Stanford Univ, Dept Anesthesia, Sch Med, Stanford, CA 94305 USA
[2] Univ Louisville, Outcomes Res Inst, Louisville, KY 40292 USA
[3] Univ Louisville, Dept Anesthesiol & Perioperat Med, Louisville, KY 40292 USA
[4] Cleveland Clin, Dept Quantitat Hlth Sci, Cleveland, OH 44106 USA
[5] Cleveland Clin, Dept Outcomes Res, Cleveland, OH 44106 USA
[6] Columbia Univ, Dept Anesthesiol, New York, NY USA
[7] Outcomes Res Consortium, Cleveland, OH USA
关键词
AUDITORY-EVOKED RESPONSE; NITROUS-OXIDE ANESTHESIA; NOXIOUS STIMULI; SEVOFLURANE ANESTHESIA; ELECTRICAL-STIMULATION; HALOTHANE ANESTHESIA; GENERAL-ANESTHESIA; SURGICAL-PATIENTS; EEG; REQUIREMENT;
D O I
10.1213/ANE.0b013e3181af631a
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
BACKGROUND: Anesthesia-induced immobility and cortical suppression are governed by anatomically separate, but interacting, areas of the central nervous system. Consequently, larger volatile anesthetic concentrations are required to suppress cortical activation than to abolish movement in response to noxious stimulation. We examined the effect of decreased afferent input, as produced by neuromuscular block (NMB), on immobility and cortical activation, as measured by Bispectral index (BIS) of the electrocardiogram, in the presence of noxious stimulation during approximately minimum alveolar concentrations (MACs) of desflurane anesthesia. METHODS: The effect of NMB on the median effective end-tidal concentration of desflurane (EtDes(50), or MAC(tetanus)) for immobility was estimated using the up-and-down method and isolated forearm technique in 24 healthy volunteers. Each volunteer sequentially received saline, mivacurium, and succinylcholine in a randomized order, while EtDes concentration during each of the treatments was determined based on the movement response of the previous volunteer on the same treatment. Nonlinear mixed-effects modeling was used to evaluate the effect of NMB on BIS versus EtDes concentration relationship at baseline and after noxious stimulation, while the frontal electromyogram (EMG(BIS)) effect on BIS was also modeled as a covariate. Cardiovascular responses to noxious stimulation were compared across treatments. RESULTS: Succinylcholine and mivacurium significantly reduced MAC(tetanus) (95% confidence interval) from 5.00% (4.85%-5.13%), during saline, to 4.05% (3.81%-4.29%) and 3.84% (3.60%-4.08%), respectively. Noxious stimulation significantly, although minimally, increased BIS response during all treatments. Succinylcholine increased BIS independently of an effect on EMG(BIS), Succinylcholine administration increased cardiovascular activity. Interestingly, although cardiovascular reaction to the noxious event was ablated by mivacurium, cortical response, as determined by BIS, was retained. CONCLUSIONS: Both succinylcholine and mivacurium enhanced immobility during near-MAC anesthesia. All treatments were associated with a small, although significant, BIS increase in response to noxious stimulation, whereas succinylcholine increased BIS independently of noxious stimulation or EMG(BIS). Mivacurium. suppressed autonomic response to a noxious event. (Anesth Analg 2009;109:1097-1104)
引用
收藏
页码:1097 / 1104
页数:8
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