在药物诱导睡眠内窥镜检查过程中，不同的异丙酚应用模式对镇静过程的影响。

IF 1.6 4区医学 Q2 OTORHINOLARYNGOLOGY Laryngoscope Investigative Otolaryngology Pub Date : 2024-06-17 DOI:10.1002/lio2.1258

Yehor Polievoi, Daniel Grafmans MD, Mariia Skliar, Andrea Kossatz MD, Jens Soukup MD, PhD, Patrick Kellner MD, PhD, Beatrice Herzog PhD, Michael Herzog MD, PhD

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引用次数: 0

摘要

目的：药物诱导睡眠内窥镜检查（DISE）期间的镇静过程取决于镇静药物的应用模式。镇静的深度也应模仿轻度和深度睡眠。此外，在轻度和深度镇静期间应尽可能多地观察呼吸周期。本研究的目的是评估使用异丙酚的不同剂量对达到的镇静深度和镇静时间的影响：连续对 63 名阻塞性睡眠呼吸暂停和/或鼾症患者进行 DISE，随机使用异丙酚灌注镇静，采用七种不同的使用模式：每个灌注器 14、16、18、19、20、22 毫克/千克/小时（0.233、0.267、0.3、0.317、0.333、0.367 毫克/千克/分钟），每次栓注 10 毫克。镇静深度由 BiSpectral Index™ (BIS) 监测。分析了基线参数和镇静过程的影响：结果：用药量是影响镇静深度的唯一因素。基本参数（性别、年龄、体重指数、呼吸暂停-低通气指数）对镇静深度没有影响。镇静深度取决于异丙酚的使用剂量。14 和 16 毫克/千克/小时的剂量以及栓剂剂量都无法使 BIS 达到代表深度睡眠的 50 以下水平。异丙酚剂量超过 20 毫克/千克/小时会导致镇静水平迅速下降到深度睡眠水平以下。丙泊酚剂量在 18 至 20 毫克/千克/小时之间时，BIS 水平可低于代表深度睡眠的 50，并为观察提供足够的呼吸周期：结论：较低的异丙酚使用率可提供较慢的镇静过程和较浅的镇静深度。14 毫克/千克/小时的剂量可能适合在浅睡眠时达到镇静高点。18 毫克/千克/小时的剂量则可达到深度睡眠时的镇静效果。两种速率的组合可能是进行镇静控制型 DISE 的合适模式。

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The influence of different application patterns of propofol on the sedation courses during drug-induced sleep endoscopy

Objective

The course of sedation during drug-induced sleep endoscopy (DISE) depends on the application pattern of the sedative drug. The depth of sedation should imitate light and deep sleep as well. Moreover, there should be as many breathing cycles as possible available for observation during light and deep sedation. The aim of the study was to evaluate different rates of propofol application with respect to the achieved depth and length of the course of sedation.

Methods

Sixty-three consecutive patients with obstructive sleep apnea and/or snoring undergoing DISE were randomly sedated by propofol perfusion at seven different application patterns: 14, 16, 18, 19, 20, 22 mg/kg/h (0.233, 0.267, 0.3, 0.317, 0.333, 0.367 mg/kg/min) per perfusor and individual bolus application 10 mg each. Sedation depth was monitored by BiSpectral Index™ (BIS). The influence of baseline parameters and the courses of sedation were analyzed.

Results

The application rate was the only factor that influenced the depth of sedation. Basic parameters (gender, age, body mass index, apnea-hypopnea index) had no influence on the depth of sedation. The sedation depth was dependent on the rate of propofol application. Regimes at 14 and 16 mg/kg/h as well as bolus application did not reach BIS levels below 50 representing deep sleep. Propofol doses of more than 20 mg/kg/h led to rapid decreases of sedation levels below deep sleep niveau. Propofol rates between 18 and 20 mg/kg/h enable BIS levels below 50 representing deep sleep and providing enough breathing cycles for observation.

Conclusion

Lower application rates of propofol provide slower courses of sedation and shallower depths of sedation. A rate of 14 mg/kg/h might be appropriate to reach a sedation plateau at light sleep. A rate of 18 mg/kg/h leads to a sedation, corresponding to deep sleep. The combination of both rates might be a suitable pattern for performing sedation-controlled DISE.