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Closed-loop control of propofol anaesthesia

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BritishJournalofAnaesthesia83(2):223–8(1999)Closed-loopcontrolofpropofolanaesthesiaG.N.C.Kenny1*andH.Mantzaridis21UniversityDepartmentofAnaesthesia,GlasgowRoyalInfirmary,8–16AlexandraParade,

GlasgowG312ER,UK.2DepartmentofAnaesthetics,VictoriaInfirmaryNHSTrust,Langside,

GlasgowG429TY,UK

*Correspondingauthor

Wedescribetheuseofaclosed-loopsystemtocontroldepthofpropofolanaesthesiaautomatically.Weusedtheauditoryevokedpotentialindex(AEPindex)astheinputsignalof

thissystemtovalidateitasatruemeasureofdepthofanaesthesia.AuditoryevokedpotentialswereacquiredandprocessedinrealtimetoprovidetheAEPindex.TheAEPindexwasusedina

proportionalintegral(PI)controllertodeterminethetargetbloodconcentrationofpropofolrequiredtoinduceandmaintaingeneralanaesthesiaautomatically.Westudied100spon-taneouslybreathingpatients.ThemeanAEPindexbeforeinductionofanaesthesiawas73.5(

SD

17.6),duringsurgicalanaesthesia37.8(4.5)andatrecoveryofconsciousness89.7(17.9).

Twenty-twopatientsrequiredassistedventilationbeforeincision.Afterincision,ventilationwasassistedinfourofthese22patientsformorethan5min.Therewasnoincidenceofintraoperativeawarenessandallpatientswerepreparedtohavethesameanaestheticinfuture.Movementinterferingwithsurgerywasminimal.Cardiovascularstabilityandoverallcontrolofanaesthesiaweresatisfactory.

BrJAnaesth1999;83:223–8Keywords:anaesthesia,depth;anaesthesia,general;anaestheticsi.v.,propofol;memory;brain,evokedpotentials;monitoring,evokedpotentials

Acceptedforpublication:March2,1999

Anaesthesiahasbeendefinedas‘thatstatewhichensuresthesuppressionofthesomaticandvisceralsensorycomponents,andthustheperceptionofpain’.1Beforetheintroductionofneuromuscularblockingdrugsintoanaestheticpractice,movementofthepatientprovidedaclearindicationofdepthofanaesthesia.However,whenneuromuscularblockingdrugsareadministered,theavailabilityofpatientmovementasavaluablesignoftheinadequacyofanaesthe-siaislostandreliancehasbeenplacedonindirectsigns.Therehavebeenmanyreportsofpatientsbeingawareduringsurgery2–5andconsiderableeffortshavebeenmadetodevelopareliableindexofdepthofanaesthesia.Auditoryevokedpotentials(AEP)havebeenreportedtofulfilmanyoftherequirementsformeasurementofthelevelofanaesthesia.6–10Inparticular,theAEPhasbeenshowntoprovidegooddiscriminationofthetransitionfromasleeptoawakeandviceversa.1011WehavedevelopedasystemtoobtainasingleindexwhichrepresentsthemorphologyoftheAEP12–15andusedthisindexastheinputsignalforclosed-loopanaesthesia(CLAN)duringsurgeryinpatientswhodidnotreceiveneuromuscularblockingdrugs.PatientsandmethodsAfterobtainingapprovalfromtheHospitalEthicsCommit-teeforevaluationoftheCLANsystemandwritteninformed©BritishJournalofAnaesthesiaconsent,westudied100ASAIorIIpatients,meanage50(range19–83)yrandmeanweight66(40–108)kg,undergoingbodysurfacesurgery.Allwereabletounder-standthepurposeofthestudy.Therewerenootherexclusioncriteria.Patientsreceivedtemazepamforpremedicationapproximately1hbeforesurgery.Youngpatientsreceivedtemazepam30mgandolderpatientsreceivedtemazepam20mg.Day-casepatientsdidnotreceivepremedication.

AuditoryevokedpotentialacquisitionIntheoperatingtheatre,patientswereconnectedtotheCLANsystem.AEPwereobtainedusingasystemdescribedpreviously10–14fromthreeelectrodesplacedattherightmastoid(ϩ)andmiddleforehead(–),withFp2asthereference.Theamplifierwascustom-builtwitha5-kVmedicalgradeisolation.Ithadacommonmoderejectionratio(CMRR)of170dBwithbalancedsourceimpedance,inputvoltagenoiseof0.3µV(10Hz–1kHzrms)andcurrentinputnoiseof4pA(0.05Hz–1kHzrms).Athird-orderButterworthanalogueband-passfilterwithabandwidthof1–220Hzwasused.Theclickswere70dBabovethenormalhearinglevelandhadadurationof1ms.Theywerepresentedatarateof6.9s–1tobothears.The

amplifiedEEGwassampledatafrequencyof1778Hzbya12-bitanalogue-to-digitalconverterandwasprocessedinreal-timebyamicrocomputer.KennyandMantzaridisTable1Inductionalgorithm.Step2wasrepeateduptothreetimes.ThealgorithmwasinterruptedandthesystemswitchedtotheproportionalintegralcontrolalgorithmwhenthedesiredAEPindexwasobtainedPremedicatedUnpremedicated(n⍧67)(n⍧33)Step1Initialtargetpropofolconcentration2.0µgml–14.0µgml–1Waitfor50s40sStep2Increasetargetby1.0µgml–11.5µgml–1Waitfor50s40sRepeatupto3times3timesStep3Thereafterincreasetargetby1.0µgml–11.5µgml–1Every60s60sAEPwereproducedbyaveraging256sweepsof144msduration.Thetimerequiredtohaveafullupdateofthesignalwas36.9s,butamovingtimeaveragingtechniqueallowedafasterresponsetimetoanychangeinthesignal.AEPwereobtainedat3-sintervalsandtheAEPindex(AEPindex),amathematicalderivativereflectingthemorpho-logyoftheAEP,wascalculatedautomatically.TheAEPindexisdefinedasthesumofthesquarerootoftheabsolutedifferencebetweeneverytwosuccessivesegmentsoftheAEPwaveform.11–14The3-srunningaverageoftheAEPindexwasenteredintoaproportionalintegral(PI)controlalgorithm.Thealgorithmcalculatedtherequiredalterationinthetargetbloodconcen-trationofpropofolfromthedifferencebetweenthemeasuredAEPindexandthecontrolvalueoftheAEPindex(AEPindexcontrol)selectedbytheanaesthetist.Thenewvalueforthetargetpropofolconcentrationwastransmittedtothetarget-con-trolledinfusion(TCI)systemwhichusedapharmacokineticmodel16toachieveandmaintaintherequiredtargetconcen-trationsetbythePIcontrolalgorithm.ThevaluefortheAEPindexwasrecordedwiththepatientawakeandtheanticipatedAEPindexcontrolforsatisfactoryanaesthesiawasenteredintotheCLANsystem.PreviousexperienceusingtheAEPindexasamonitoroftheadequacyofanaesthesia1115suggestedarangeof30–40fortheAEPindexcontrol.AnaesthesiawasinducedautomaticallybytheCLANsystemusingapredeterminedseriesofincreasingtargetbloodpropofolconcentrations(Table1)untiltheAEPindexwasequaltotheselectedAEPindexcontrolϩ10.There-after,controlofanaesthesiawasachievedbytransmittingthetargetbloodpropofolconcentrationcalculatedbythePIalgorithmtotheinfusionsystemandmaintainingthemeasuredAEPindexclosetotheselectedAEPindexcontrol.Atargetplasmaconcentrationofalfentanil15ngml–1wasachievedbeforeinductionandwasmaintainedthroughoutsurgery.17Duringmaintenanceofanaesthesia,patientsbreathedamixtureof66%nitrousoxideinoxygen.Alaryngealmaskairwaywasinsertedinallpatientstomaintainaclearairwayandtoallowmonitoringofventil-atoryfrequencyandend-tidalcarbondioxidepartialpres-sure.Arterialoxygensaturationwasmonitoredcontinuously224Table2Anaestheticandsurgicaltimes.Durationsaremean(SD)[range]minDurationofinduction3.7(1.4)[1.3–8.9]Startofinductiontoincision12.4(3.8)[5.6–27.9]Incisiontoendofsurgery37.9(26.4)[4.4–123.8]Endofsurgerytorecovery6.6(4.6)[0.0–17.9]Durationofanaesthesia56.9(28.4)[19.7–156.3]

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丙泊酚联合瑞芬太尼麻醉用于无痛人流中的效果观察

丙泊酚联合瑞芬太尼麻醉用于无痛人流中的效果观察

2011年9月第49卷第26期·临床麻醉·丙泊酚联合瑞芬太尼麻醉用于无痛人流中的效果观察龙家棋（廉江市人民医院麻醉科，广东廉江 524400）[摘要] 目的 探讨丙泊酚联合瑞芬太尼麻醉用于无痛人流中的效果观察。

方法 选取2010年1月～2011年1月我院人工流产患者160例，随机分为实验组与对照组各80例，其中实验组患者采用丙泊酚联合瑞芬太尼麻醉，对照组患者单纯采用丙泊酚麻醉。

观察和记录患者的镇痛效果、临床情况及不良反应。

结果 实验组总有效率达100.0%，与对照组比较差异具有统计学意义（P＜0.05）；两组患者的丙泊酚用量、苏醒时间、离院时间及体动率差异均具有统计学意义（P ＜0.05）；实验组出现不良反应较少（P＜0.05）。

结论 丙泊酚联合瑞芬太尼麻醉为人工流产患者提供了良好的镇痛镇静条件，既安全又有效，值得在临床上推广应用。

[关键词] 丙泊酚；瑞芬太尼；无痛人流；麻醉[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2011）26-108-02The Effect of Propofol and Remifentanil on Painless Abortion SurgeryLONG JiaqiAnesthesiology Department of the People's Hospital of Lianjiang City，Guangdong Province，Lianjiang 524400，China[Abstract] Objective To learn effect of propofol and remifentanil on painless abortion surgery. Methods All 160 patients from Jan 2010 to Jan 2011 received abactio divided into 2 groups. The experiment group received propofol and remifentanil while control group received propofol. The analgesia effect and clinic state and untoward effect were observed. Results The diverse of total effect rate，propofol dosage，analepsia time，leave-hospital time，move rate and untoward effect of 2 groups had significant differences between two groups（P＜0.05）. It means that the experiment group had lease untoward effect. Conclusion Propofol and remifentanil is safe and effective and worth widely using.[Key words] Propofol；Rmifentanil；Painless abortion surgery；Anaesthesia人工流产作为避孕失败的补救方法之一，目前在妇产科已被广泛应用，虽属小手术，但其带来的疼痛不适给患者造成的影响越来越受重视。

环泊酚的作用机制在临床应用上的分析

环泊酚的作用机制在临床应用上的分析

Advances in Clinical Medicine 临床医学进展, 2023, 13(9), 14569-14573 Published Online September 2023 in Hans. https:///journal/acm https:///10.12677/acm.2023.1392037环泊酚的作用机制在临床应用上的分析郭明珊，热孜亚·艾尔肯，艾孜买提·艾尼瓦尔，刘玉婷*新疆医科大学附属肿瘤医院麻醉科，新疆 乌鲁木齐收稿日期：2023年8月14日；录用日期：2023年9月8日；发布日期：2023年9月15日摘要 随着舒适化诊疗的广泛开展，无痛诊疗被熟知和应用。

在麻醉诱导过程中，患者会因为丙泊酚注射痛而对手术产生恐惧及焦虑。

为减少患者对手术的未知产生紧张和焦虑的情绪，以及手术中痛苦的生理及心理影响，多数患者期望不仅在手术中有良好的镇静镇痛效果，更希望在麻醉诱导过程中没有疼痛。

为此我国学者成功研发了新药环泊酚，并取得了很好的临床效果。

环泊酚作为新型静脉麻醉药物，具有可控性好、临床安全性高等特点，本研究旨在总结环泊酚在其临床应用中的效果。

关键词环泊酚，临床应用Analysis of the Mechanism of Action of Cyclopol in Clinical ApplicationMingshan Guo, Reziya Aierken, Aizmati Ainivar, Yuting Liu *Department of Anesthesiology, Xinjiang Medical University Affiliated Oncology Hospital, Urumqi Xinjiang Received: Aug. 14th , 2023; accepted: Sep. 8th , 2023; published: Sep. 15th , 2023AbstractWith the widespread development of comfortable diagnosis and treatment, painless diagnosis and treatment are well-known and applied. During the anesthesia induction process, patients may ex-perience fear and anxiety towards surgery due to the pain caused by propofol injection. In order to reduce the tension and anxiety caused by the unknown about the surgery, as well as the physi-ological and psychological effects of pain during the surgery, most patients hope not only to have good sedative and analgesic effects during the surgery, but also to have no pain during the anes-thesia induction process. For this reason, Chinese scholars have successfully developed a new drug, *通讯作者。

医药卫生TCI静脉靶控输注的特点和临床应用

医药卫生TCI静脉靶控输注的特点和临床应用


TCI
人工控制输注
病人百分比 (主要通过观察来估计)
优良 77.6%
好 22.4%
优良 68.7%
好 27.5%
不良 0%
n = 76
n = 80
不良 3.8%
UK 的研究， ASA I or II 级病人
手术切皮时病人体动
10%
20%
30%
人工控制输注 n = 80
病人的百分比
TCI n = 76
1、不能维持麻醉药的有效浓度 2、重复给药血药浓度波动大 3、血浆浓度与效应室浓度不易平衡
静脉给药方法-单次+ 持续静脉给药
单次给药
治疗窗(Therapeutic Window)
持续静脉给药
1、起效时间长: 达稳态血浆浓度的时间长,需4 ~ 5个半衰期 2、长时间蓄积作用: 随输注时间延长，清除速率减慢，血药浓度逐渐升高产生 3、难以调节血药浓度：根据病人反应和手术刺激强度随时调节
静脉麻醉药的药代和药效学特点
静脉麻醉药物代谢大多符合三室模型 药物的麻醉作用与其靶位浓度直接相关 药物的靶位浓度因其分布、代谢、排泄而发生动态改变 给药方式和剂量直接影响这种改变
1
3
2
效应室药代动力学模型
T1/2 Keo
T1/2Keo Remifentanil 1.1min Propofol 2.6min Sufentanil 5.8min
T1/2 ke0
ke0：为血浆和效应室药物浓度达平衡的速率常数 Ke0是影响药物在效应室和中央室之间平衡的主要因素 Ke0越大，血浆与效应室达到平衡越快，药物起效越快 T1/2 Ke0=0.639/Ke0 是描述药物自血浆到效应室或自效应室消除50%的时间常数 是影响药物最大效应滞后于血浆浓度峰值的主要因素
单用环泊酚与环泊酚复合小剂量舒芬太尼在无痛胃镜检查中的镇静麻醉效果与安全性对比

单用环泊酚与环泊酚复合小剂量舒芬太尼在无痛胃镜检查中的镇静麻醉效果与安全性对比

- 37 -伤外科杂志，2017，19（9）：694-697.[6]卢艳东，李方国，苗军，等.累及后外侧髁胫骨平台的骨折与植入物选择及修复[J].中国组织工程研究，2017，21（23）：3741-3746.[7] BAUMANN F，WEBER J，MAHR D，et al. Joint awareness in posttraumatic osteoarthritis of the knee: validation of the forgotten joint score in long term condition after tibial plateau fracture[J]. Health Qual Life Outcomes，2017，15（1）：233.[8]吴磊，魏更生，吴京亮，等.关节镜辅助有限切开复位内固定治疗胫骨平台骨折[J].中国临床医生杂志，2016，44（7）：76-78.[9] LI D Q，SONG D Y，NI J D，et al. A case report of Schatzker type Ⅵ tibial plateau fracture treated with double reverse traction closed reduction combined with minimally invasive percutaneous plate osteosynthesis technique: a case report[J/OL]. Medicine (Baltimore)，2017，96（45）：e8394.https:///29137023/.[10] WANI I H，Ul GANI N，YASEEN M，et al. Operativemanagement of distal tibial extra-articular fractures-intramedullary nail versus minimally invasive percutaneous plate osteosynthesis[J]. Ortop Traumatol Rehabil，2017，19（6）：537-541.[11] HALLER J M，MARCHHAND L，ROTHBERG D L，et al.Inflammatory cytokine response is greater in acute tibial plafond fractures than acute tibial plateau fractures[J]. J Orthop Res，2017，35（12）：2613-2619.[12]邱文奎，苏振炎，张益宏，等.经皮微创钢板内固定术和传统切开复位内固定术治疗肱骨外科颈骨折对比研究[J].创伤外科杂志，2019，14（3）：249-250.[13]王剑敏，陈晓勇，黄凤琪，等.膝关节镜辅助微创手术治疗复杂性胫骨平台骨折的疗效分析[J].现代生物医学进展，2017，17（10）：1918-1920，1956.[14]姜家玺，张屹阳，李阳.微创经皮钢板内固定治疗胫骨骨折的效果及对创伤控制的效果观察[J].中国医学创新，2022，19（3）：53-57.[15]杨君，孙效虎.关节镜微创手术治疗胫骨平台骨折的临床研究[J/OL].现代医学与健康研究电子杂志，2021，5（21）：37-39.https:///paper_detail.html?id=b59b4d45821daa6655d74716ecdf49b4.[16]石武谛，柯雯昙.关节镜下经皮微创钢板内固定术与切开复位内固定术对胫骨平台骨折患者膝关节活动度、疼痛应激和炎性因子的影响比较[J].创伤外科杂志，2019，14（3）：185-186.[17]冯真国，陈兴礼，桑飞，等.不同剂量玻璃酸钠辅助手术治疗对胫骨平台骨折术后恢复与应激状态的影响[J].海南医学，2017，28（24）：4010-4014.[18]谢勇.胫骨平台骨折患者行关节镜下经皮微创钢板内固定术治疗的有效性及对患者膝关节活动度的影响[J].实用医技杂志，2021，28（9）：1138-1140.（收稿日期：2023-08-23）　（本文编辑：程旭然）①徐州医科大学附属医院　江苏　徐州　221000通信作者：徐小班单用环泊酚与环泊酚复合小剂量舒芬太尼在无痛胃镜检查中的镇静麻醉效果与安全性对比孙彪①　徐小班①【摘要】　目的：分析比较单用环泊酚与环泊酚复合小剂量舒芬太尼在无痛胃镜检查中的镇静麻醉效果与安全性。