Relationship between Bispectral Index, Sedation Score and Plasma Concentration, during Midazolam Sedation

서지정보

· 발행기관 : 대한치과마취과학회
· 수록지 정보 : Journal of Dental Anesthesia and Pain Medicine / 1권 / 1호 / 21 ~ 25페이지
· 저자명 : 김현정, 박은진, 박창주, 염광원

초록

It is very important to assess of the patient's conscious levels during sedation. But up to now, there are no direct measuring methods of hypnotic state, so the indirect assessment of the hypnotic state is performed clinically by observing physiological signs and patient responsiveness to voice or touch. For example, sedation score systems, such as sedation score, sedation rating scale, and the Ramsay scale and the Modified Observer's Assessment of Alertness/Sedation Scale have been used. But it is of no
use patients who are incapable of responding, and the stimulation for assessment itself may arouse the patient. Also subjective and spontaneous assessment have their own limitation.
Bispectral Index (BIS) is the EEG parameter to measure the effects of anesthetic agents on the patient's brain, which examines the relationships or “coupling” among the sine wave components. Specifically bispectral analysis quantifies the level of synchronization in the EEG, along with the traditional amplitude and frequency parameters. This provides better prediction of the awakening compared with conventional methods such as spectral edge frequency (SEF), median frequency, and auditory evoked potential index (Doi et al, 1997). Also, in the study of EEG measurement about the effect of alfentanyl, propofol, and midazolam, BIS was the same or better predictor than
spectral edge or delta power (Billard et al, 1997). But Stanski suggested several unsolved problems, including (1) lack of understanding of the effects of interactions of anesthetic drugs on the EEG, (2) inability to choose the
most appropriate EEG parameters, and (3) lack of a gold standard of clinical drug effect for comparison (Stanski,1990).
This study was designed to clearly define the relationship between clinical assessment of consciousness state after administration of midazolam and BIS, sedation score, and plasma drug concentration. By comparing these parameters, we verified the prediction accuracy of BBS.

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