婴儿异丙酚麻醉期间临床终点的脑电图指标--异丙酚生物标记物早期阶段研究。

IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Anesthesiology Pub Date : 2024-08-01 DOI:10.1097/ALN.0000000000005043
Ian Yuan, Annery G Garcia-Marcinkiewicz, Bingqing Zhang, Allison M Ulrich, Georgia Georgostathi, Richard M Missett, Shih-Shan Lang, James L Bruton, C Dean Kurth
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引用次数: 0

摘要

背景:与呼出的七氟醚浓度不同,异丙酚缺乏脑效应部位浓度(Ce)的生物标志物,导致剂量不精确,尤其是在婴儿中。脑电图(EEG)监测可作为异丙酚浓度的生物标志物,但专有的脑电图指数尚未在婴儿中得到验证。我们评估了作为婴儿异丙酚麻醉生物标记物的频谱边缘频率(SEF95)。我们假设 SEF95 的目标值会因不同的临床刺激而变化,并且 SEF95 与异丙酚血浆浓度之间存在反比关系:这项前瞻性研究招募了婴儿(3-12 个月),以确定三个麻醉临床终点(意识-安放镇定剂、疼痛-电神经刺激、插管-喉镜检查)的 SEF95 范围,以及 SEF95 与稳定状态下丙泊酚血浆浓度之间的相关性。迪克森上-下法用于确定每个临床终点的目标 SEF95。中心等渗回归确定了 SEF95 的剂量-反应函数,其中 50% 和 90% 的婴儿(ED50 和 ED90)对临床终点无反应。线性混合效应模型确定了异丙酚血浆浓度与SEF95的关系:在 49 名登记的婴儿中,44 名可评估婴儿(90%)对以下终点表现出明显的 SEF95:安抚奶嘴(ED50 21.4Hz,ED90 19.3Hz)、电刺激(ED50 12.6Hz,ED90 10.4Hz)和喉镜检查(ED50 8.5Hz,ED90 5.2Hz)。从 0.5-6 μg/ml 异丙酚开始,1 Hz SEF95 的增加与 0.24(95% CI:0.19 - 0.29,pConclusions)的线性相关:SEF95 可以作为婴儿异丙酚麻醉深度的生物标志物,从而有可能提高异丙酚麻醉在这一人群中的剂量准确性和利用率。
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Electroencephalographic Indices for Clinical Endpoints during Propofol Anesthesia in Infants: An Early-phase Propofol Biomarker-finding Study.

Background: Unlike expired sevoflurane concentration, propofol lacks a biomarker for its brain effect site concentration, leading to dosing imprecision particularly in infants. Electroencephalography monitoring can serve as a biomarker for propofol effect site concentration, yet proprietary electroencephalography indices are not validated in infants. The authors evaluated spectral edge frequency (SEF95) as a propofol anesthesia biomarker in infants. It was hypothesized that the SEF95 targets will vary for different clinical stimuli and an inverse relationship existed between SEF95 and propofol plasma concentration.

Methods: This prospective study enrolled infants (3 to 12 months) to determine the SEF95 ranges for three clinical endpoints of anesthesia (consciousness-pacifier placement, pain-electrical nerve stimulation, and intubation-laryngoscopy) and correlation between SEF95 and propofol plasma concentration at steady state. Dixon's up-down method was used to determine target SEF95 for each clinical endpoint. Centered isotonic regression determined the dose-response function of SEF95 where 50% and 90% of infants (ED50 and ED90) did not respond to the clinical endpoint. Linear mixed-effect model determined the association of propofol plasma concentration and SEF95.

Results: Of 49 enrolled infants, 44 evaluable (90%) showed distinct SEF95 for endpoints: pacifier (ED50, 21.4 Hz; ED90, 19.3 Hz), electrical stimulation (ED50, 12.6 Hz; ED90, 10.4 Hz), and laryngoscopy (ED50, 8.5 Hz; ED90, 5.2 Hz). From propofol 0.5 to 6 μg/ml, a 1-Hz SEF95 increase was linearly correlated to a 0.24 (95% CI, 0.19 to 0.29; P < 0.001) μg/ml decrease in plasma propofol concentration (marginal R2 = 0.55).

Conclusions: SEF95 can be a biomarker for propofol anesthesia depth in infants, potentially improving dosing accuracy and utilization of propofol anesthesia in this population.

Editor’s perspective:

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来源期刊
Anesthesiology
Anesthesiology 医学-麻醉学
CiteScore
10.40
自引率
5.70%
发文量
542
审稿时长
3-6 weeks
期刊介绍: With its establishment in 1940, Anesthesiology has emerged as a prominent leader in the field of anesthesiology, encompassing perioperative, critical care, and pain medicine. As the esteemed journal of the American Society of Anesthesiologists, Anesthesiology operates independently with full editorial freedom. Its distinguished Editorial Board, comprising renowned professionals from across the globe, drives the advancement of the specialty by presenting innovative research through immediate open access to select articles and granting free access to all published articles after a six-month period. Furthermore, Anesthesiology actively promotes groundbreaking studies through an influential press release program. The journal's unwavering commitment lies in the dissemination of exemplary work that enhances clinical practice and revolutionizes the practice of medicine within our discipline.
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