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Propofol–Bispectral Index (BIS) Electroencephalography (EEG) Pharmacokinetic-Pharmacodynamic Model in Patients With Post–Cerebral Hemorrhage Hydrocephalus
Clinical EEG and Neuroscience ( IF 2 ) Pub Date : 2020-06-11 , DOI: 10.1177/1550059420932042
Ashraf A Dahaba 1 , Han Lin 2 , Xue Fei Ye 2 , Nu Zhang 3 , Kun Wang 4 , Gilbert Reibnegger 5 , Qing Quan Lian 2
Affiliation  

Background. Titrating hypnotic agents for patients who suffer from a cerebral insult is a challenging task. To date there is no real gold standard to precisely quantify electroencephalography (EEG) response in a fashion that could be utilized for patients with post-cerebral hemorrhage hydrocephaly. While we must administer "as per usual" analgesics for noxious stimuli, we have to administer the hypnotic agents more "sparingly" due to lack of objective monitoring. Methods. We compared 15 adult post-cerebral hemorrhage hydrocephalus patients undergoing ventriculo-peritoneal shunt placement with 15 controls matched for gender and approximate age. We set propofol target controlled infusion estimated plasma concentrations (Cp) to gradually reach 4 µg/mL over 4 minutes. To precisely quantify post-cerebral hemorrhage mental dysfunction, we used electronically retrieved bispectral index (BIS) and propofol Cp data points to create individual inhibitory monophasic mathematical model for each patient that incorporates an independent hysteresis "lag" function. Results. In post-cerebral hemorrhage patients Cp-BIS curve, C50 (propofol concentration associated with inhibitory 50% BIS response) cutoff point was significantly shifted to the left by 39%. Whereas before infusion and at stable propofol 4 µg/mL aneurismal surgical sides ipsilateral (75 ± 13, 25 ± 9) and contralateral (73 ± 15, 27 ± 9) mean ± SD BIS values were significantly lower than ipsilateral (95 ± 3, 46 ± 12) and contralateral (94 ± 3, 46 ± 12) matched controls. Conclusions. Using BIS as surrogate marker of propofol hypnotic effect, BIS monitoring in patients with post-cerebral hemorrhage hydrocephaly showed a pattern of change and trend that was similar albeit 39% significantly lower than subjects without.

中文翻译:

脑出血后脑积水患者的丙泊酚-双频指数 (BIS) 脑电图 (EEG) 药代动力学-药效学模型

背景。为患有脑损伤的患者滴定催眠药是一项具有挑战性的任务。迄今为止,还没有真正的黄金标准可以以可用于脑出血后脑积水患者的方式精确量化脑电图 (EEG) 反应。虽然我们必须“照常”使用镇痛剂来治疗有害刺激,但由于缺乏客观监测,我们必须更加“谨慎”地使用催眠药。方法。我们将 15 名接受脑室-腹腔分流术的成人脑出血后脑积水患者与 15 名性别和年龄相匹配的对照进行了比较。我们将丙泊酚目标控制输注估计血浆浓度 (Cp) 设置为在 4 分钟内逐渐达到 4 µg/mL。为了精确量化脑出血后的精神功能障碍,我们使用电子检索的双谱指数 (BIS) 和丙泊酚 Cp 数据点为每位患者创建单独的抑制性单相数学模型,该模型包含独立的滞后“滞后”函数。结果。在脑出血后患者的 Cp-BIS 曲线中,C50(丙泊酚浓度与抑制性 50% BIS 反应相关)截止点显着向左移动了 39%。而在输注前和稳定丙泊酚 4 µg/mL 动脉瘤手术侧同侧 (75 ± 13, 25 ± 9) 和对侧 (73 ± 15, 27 ± 9) 平均值 ± SD BIS 值显着低于同侧 (95 ± 3, 46 ± 12) 和对侧 (94 ± 3, 46 ± 12) 匹配对照。结论。使用 BIS 作为丙泊酚催眠作用的替代标志物,
更新日期:2020-06-11
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