Spinal anestezi sırasında sedasyonun BIS ile monitörizasyonu

Bu çalışmada, spinal anestezi uygulanan hastalarda sedasyonu değerlendirmek için Bispektral indeks (BIS) ve Gözlemcinin Uyanıklık ve Sedasyon Değerlendirme Skalası (Observer's Assessment of Alertness/ Sedation Scale- OAA/S) arasındaki korelasyonun araştırılması amaçlandı. Spinal anestezi uygulanacak 51 hasta randomize şekilde 3 gruba ayrıldı. Kontrol grubuna (n=17) sedatif ilaç uygulanmadı. Propofol grubuna (n=17) spinal blok yapılmadan önce 5 dakika süreyle 75 $mu$g $kg^-1$ $dk^-1$olacak şekilde iv propofol infüzyonu uygulandı, daha sonra 50 $mu$g $kg^-1$ $dk^-1$ hızında infüzyona devam edildi ve cerrahinin tamamlanmasıyla birlikte sonlandırıldı. Midazolam grubuna (n=17) ise 25 $mu$g $kg^-1$ başlangıç dozunu takiben 5 dakika süreyle 0.5 $mu$g $kg^-1$ $dk^-1$ hızında intravenöz midazolam infüzyonu uygulandı; blok yapıldı ve infüzyona aynı hızda devam edildi. Kalp atım hızı, ortalama arter basıncı ve oksijen saturasyonu ile birlikte BIS değerleri ve OAA/S skorları cerrahi sırasında ve sonrasında belirli aralıklarla kaydedildi. Sedasyon derinliğinin artması ile birlikte hem BIS hem de OAA/S skorlarında azalma oldu. Spinal blok sonrası 30. dakikadaki BIS değerinin bazal değere oranla anlamlı ölçüde düşük olduğu tespit edildi.Bütün gruplarda, değerlendirme yapılan süre boyunca BIS değerleri ile OAA/S skorları arasında çok iyi bir korelasyon gözlendi. Sonuç olarak spinal anestezi sırasında propofol ve midazolam ile oluşturulan sedasyonu değerlendirmek için OAA/S' nin bis-pektral indekse alternatif olarak kullanılabileceği sonucuna varıldı.

Anahtar Kelimeler:

Anestezi, spinal, Propofol, Midazolam, Bilinçli sedasyon

Bispectral index monitoring of sedation during spinal anesthesia

We evaluated bispectral index (BIS) levels, and the correlation between Observer's Assessment of the Alertness/ Sedation scale (OAA/S) and their corresponding BIS levels during spinal anesthesia with or without intravenous sedation. Fifty-one patients undergoing spinal anesthesia were randomly assigned into three groups. The control group (n=17) received no sedative medication. The propofol group (n=17) received an infusion of propofol 75 $mu$g $kg^-1$ $min^-1$ for 5 minutes before spinal block placement, followed by propofol 50 $mu$g $kg^-1$ $min^-1$, the infusion being terminated at the completion of the surgery. The midazolam group (n=17) received an initial dose of midazolam 25 $mu$g $kg^-1$ followed by 0.5 $mu$$kg^-1$ $min^-1$ intravenously for 5 minutes. The block was performed, and the infusion continued at the same rate. Assessments of vital signs, including mean arterial pressure, heart rate, oxygen saturation and BIS levels and sedation scores determined by the responsiveness portion of the observer's assessment of the alertness/ sedation scale (OAA/S), which was recorded at certain intervals during and after the procedure. BIS values at the 30th minute after spinal block were significantly lower than baseline. In patients receiving sedation, BIS levels correlated well with sedation scores throughout the evaluation period. Increasing depth of sedation was associated with a progressive decrease in the BIS and OAA/S values. In conclusion, OAA/S is an acceptable alternative to BIS for assessing propofol and midazolam sedation during spinal anesthesia.

Keywords:

Anesthesia, Spinal, Propofol, Midazolam, Conscious Sedation,

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