Monitoring and evaluating of cerebral state index in the induction of anesthesia with targetcontrolled infusion with propofol and remifentanil / 中国医师进修杂志

ABSTRACT

ObjectiveTo evaluate the accuracy of cerebral state index (CSI) as an indicator of anesthesia depth in the induction of anesthesia with target-controlled infusion (TCI) with propofol and remifentanil patients.Methods Forty-four ASA Ⅰ or Ⅱ patients undergoing elective surgery were anesthetized with TCI with propofol and remifentanil.Anesthesia was induced with TCI with remifentanil and propofol.The target effect-site concentration of remifentanil was 4 ng/ml.The initial effect-site concentration of propofol was 1.5 μ g/ml and was increased by0.5 μ g/ml every 4 min,till 1 min after the level of observer’s assessment of alertness sedation (OAA/S) score was 0 score.Electric tetanic stimulation was given when the level of OAA/S score was 1 score.The CSI,mean arterial pressure (MAP),heart rate (HR),OAA/S score and the effect-site concentration of propofol were recorded.ResultsCSI values declined with the decrease of OAA/S score,CSI was 91 ±5,77 ±7,70 ±7,62 ±6,49 ± 12,36 ± 10 at OAA/S score with 5,4,3,2,1score.CSI values were statistically different between 0 score and 1 score,1 score and 2 scores,3 scores and 4 scores,4 scores and 5 scores of OAA/S score(P ＜0.05).The differences of MAP,HR had no statistical significance between two scores of OAA/S score (P ＞0.05).The Spearman rank correlation coefficients between CSI,MAP,HR and OAA/S score were 0.899,0.342,0.125,respectively.The prediction probabilities to differentiate different OAA/S score for CSI,MAP,and HR were 0.89 ± 0.05,0.62 ± 0.08,0.53 ±0.11,respectively.There was linear regression relationship between CSI and the effect-site concentration of propofol (the coefficient of determination was 0.812,P ＜ 0.01 ).ConclusionDuring the induction of patients with TCI with propofol and remifentanil,the CSI is accurate as an indicator of awakening and different levels of consciousness after anesthesia,and can reliably predict the anesthesia depth.