RU1796149C - Method for determining adequacy of administered anesthesia - Google Patents

Abstract

The invention relates to medicine, namely to anesthesiology. The method improves the accuracy of assessing the adequacy of induction anesthesia. To this end, the signs of the manifestation of activity of the right and left hemispheres of the brain in the motor, sensory and mental spheres are successively determined, the profile coefficient of interhemispheric asymmetry is calculated before and against the background of introductory anesthesia, the difference of the obtained coefficients is found and at values of 0.33-0. 66 introductory anesthesia was determined to be adequate.

Description

The invention relates to medicine, in particular to anesthesiology and physiology of the human brain, and can be mainly used to assess the adequacy of introductory anesthesia and control the depth of anesthesia.

A known method for determining the depth of anesthesia by recording and analyzing an electroencephalogram of bioelectrical activity of the brain.

Insufficient accuracy, the impossibility of correction of changes, the obligatory use of complex, special equipment are significant negative aspects of this method.

A known method for determining the functional state of the cerebral hemispheres by detecting the existing asymmetry. The method consists in establishing the asymmetries of the motor, sensory and mental spheres and evaluating the state of the human brain. The lack of a single quantitative measure of brain asymmetry and the inability to use the method to assess the adequacy of introductory anesthesia are its disadvantages.

The purpose of the invention: improving the accuracy of the assessment of adequacy and ensuring the safety of induction anesthesia.

The essence of the invention lies in the fact that before the start of anesthesia, the profile of the patient’s brain state is determined from the totality of the reflected functions of the hemispheres in the motor, sensory and mental spheres with the calculation of the coefficient of the profile of interhemispheric asymmetry according to the formula:

TO

p I p - 1

I "i-2Ri

P |

X "+ SRi

i t i 1

where K is the coefficient of the profile of the interhemispheric asymmetry of the patient, with R (right) and I (left) aggregate of quantitative values of hemisphere activity in the motor, sensory and mental spheres;

n i 2) 05 - set of values recognized1 1

Coverage (x (left) hemispheres in each 1st observation;

Xi

YU

ABOUT

and "-A

n 1

Г Rj - the set of corresponding

the values of the signs of the manifestation of the R (right) hemisphere in the same i-th observation;

n is the number of observations.

Then, the given period of induction anesthesia is determined by this coefficient using the same formula, and the difference of the two coefficients is calculated. With a difference value ranging from 0.33 to 0.66, introductory anesthesia is considered adequate, with a difference outside the range of 0.66-excessive, and with values less than 0.33-insufficient.

Distinctive features of the method are: determination of the coefficient of the profile of interhemispheric asymmetry in norm, its same in altered states of consciousness and higher mental functions during induction of anesthesia, the establishment of differences between the coefficients of interhemispheric asymmetries in altered states of consciousness.

The invention is illustrated by the following example.

Patient P., 74 years old, 60 kg, height 170 cm. A plan was carried out. IV intravenous anesthesia was performed with cystoscopy. Prior to anesthesia, the profile coefficient of interhemispheric asymmetry was established as follows: the set of signs of manifestation of the right hemisphere (R1) is equal to -2 signs in the motor (motor) sphere, 2 signs to the sensory one, and 2 signs to the mental one. The set of signs of the manifestation of the left hemisphere of the same observation is equal in the motor sphere to 7 signs, sensory to 3 signs, mental to 6 signs. Hence, the values of the set of signs of manifestations of the right (Ri) and left (L1) hemispheres are respectively equal

n 1 ..-.--. Ri (2 + 2 + 2H,

 : --- P 1

Y, b (7 + 3 + 6) 16.1 - 1

Substituting the values of the populations in the formula, we obtain the expression:

1 {| t + o-45

After premedication, a new introductory anesthesia was started by internal infusion of a ketamine-fentanyl mixture (100 mg ketamine, 0.2 mg phentalin, sodium chloride

0.9% to 20 ml). The introduction of 4 ml of the mixture and, after 1.5 minutes, the K2 hemisphere asymmetry profile coefficient was calculated from the totality that arose after the administration of the drugs, signs of manifestation of the right (R2) and left (L2) hemispheres in the motor, sensory and mental spheres. The totality (R2) consists of signs in the motor sphere (2), sensory (1), mental (4); the totality (L2), in the same observation, has 2 signs in the motor and sensory spheres, and 6 signs in the mental. Given the values of the aggregates, we calculate the coefficient K2- + 0.17.

We determine the difference 0) of the obtained coefficients:

j K1 -K2 +0.45 - (+ 0.17) 0.28. Comparing the value of the obtained difference O 0.28) with the boundaries determined by the method, the set (0.33 - 0.66) will evaluate the initial anesthesia as insufficient. This is also evidenced by the patient's condition: disoriented, speech difficult, answers monosyllables or in signs, reacts to pain irritations with facial expressions.

Additionally introduced 6 ml. of the mixture and, after 50 seconds, the totality of the signs of the manifestations of the right (R3) and left (L3) hemispheres was estimated, the coefficient of the profile of interhemispheric asymmetry was calculated (, 08). The determined difference Q) of the obtained coefficients (R1 and KZ) is 0.37, compared with the set (0.33 - 0.66). Introductory anesthesia has been determined to be adequate. it

confirms the condition of the patient: is in a medical dream, outwardly calm, there is no contact with him, breathing is not disturbed, there are no hemodynamic disorders. Does not respond to painful manipulations.

Using the method for assessing the adequacy of introductory anesthesia made it possible to control the depth of change in higher brain functions during anesthesia, safely

to carry out painful manipulation (lasting 35 minutes) without disorders of the respiratory system, blood circulation and other complications in a patient with severe concomitant pathology. 7 minutes after anesthesia, the patient regained consciousness without residual and emotionally unpleasant experiences. This is confirmed by a subjective assessment of the patient himself, data from subsequent observation.

 ... - -

Claims (1)

SUMMARY OF THE INVENTION A method for determining the adequacy of introductory anesthesia by recording and analyzing physiological parameters, which, in order to improve accuracy, consistently determines the signs of activity of the right and left cerebral hemispheres in the motor, sensory and mental spheres, calculates the coefficient profile of interhemispheric asymmetry before and against the background of induction anesthesia according to the formula n 1 n 1 IGI-SR. eleven n 1 where 5) QJ - a set of values recognized i 1 manifestations of the left cerebral hemisphere ;. paragraph 1. In RI - the set of values recognized manifestations of the right cerebral hemisphere, the difference between the obtained coefficients is found and, at values of 0.33-0.66, introductory anesthesia is determined to be adequate. I p 1 IOI + SR,  1 1 1