課件案例masimo國(guó)際pi mizuno perfusion index and pvi esa

Euroanaesthesia2009Meeting(Milan,Italy,6June-9JunePerfusionIndexandPlethVariabilityIndexafterAdministrationofGeneralAnestheticAgentsJuMizuno1),SatoshiKakinuma1),Shigeho1)DepartmentofAnesthesiology,TeikyoUniversitySchoolofMedicine,Tokyo173-8605,2-11-1,Kaga,Itabashi-ku,Tokyo173-8605,BackgroundandHemodynamicsmaygreatlychangeduringinductionofgeneralanesthesia.Generally,anestheticagentsdilateperipheralvesselsandincreaseperipheralperfusionbyinhibitingthesympatheticnervoussystem.Respiratoryvariationsinthepulseoximetryphotoplethysmographicwaveformamplitudehavebeenshowntocorrelatewithchangesinventricularpreloadandpredictionoffluidresponsivenessinanesthetizedmechanicallyventilatedpatients.Recently,anewnon-invasivedevice(Radical7pulseoximetermonitor,MasimoCorp.,USA)hasbeenintroducedthatcontinuouslydetectschangesinthePhotoplethysmographicwaveformandcomputesaPerfusionIndex(PI）reflectingperipheralperfusionandPhotoplethysmographyVariabilityIndex(PVI)reflectingfluidstatusandpreload.Inthisstudy,weinvestigatedthechangesinPIandPVIbeforeandafteradministrationofgeneralanestheticagents.MaterialsandThisstudywasapprovedbytheEthicsCommitteeofTeikyoUniversitySchoolofMedicine,andwritteninformedconsentwasobtainedfromeachpatient.AdultpatientswithunpremedicatedASAIandIIunderwentselectiveoperationundergeneralanesthesia.Themethodofgeneralanesthesiawasdecidedbyeachanesthesiologist.Thepulseoximetersensorwascedontheindexfingeroftheupperlimbwithoutbloodpressurecuff.Weprospectivelyrecordedstudydatabeforeadministrationofgeneralanestheticagentsandbeforetrachealintubationorinsertionoflaryngealmask(LMA).Studydataincludedhemodynamicmeasurementssuchassystolicbloodpressure(sBP)andheartrate(HR),andoxygensaturationbypulseoximetry(SpO2)aswellasPIandPVI.Fluidwasadministeredcontinuouslyat10ml/kg/hrduringtheanesthesiainduction.Thecaseswithadministrationofvasoactiveagentsandatropineduringanesthesiainductionwereexcludedfromthisstudy.Resultsand21patients（46±15year-old,M/F=11/10）underwentoperationsundergeneral19patientsweretracheallyintubatedand2patientswereinsertedLMAin.Oxygen,sevoflurane,propofol,fentanyl,remifentanil,vecuronium,rocuronium,or,succinylcholinewereusedasgeneralanestheticagents.TimeintervalbeforeadministrationofgeneralanestheticagentsandbeforetrachealintubationorinsertionofLMAwas7±2min.Afteradministrationofgeneralanestheticagents,sBPsignificantlydecreasedfrom142±29andSpO2significantlyincreasedfrom99.0±1.2to99.6±0.7%（p<0.05）.PIsignificantlyto17.1±7.2（p<0.05）.fluidadministrationfluidadministrationduringanesthesiastatusandpreloadafteradministrationofgeneralanestheticagentsandurresultsindicateanincreaseinperipheralperfusionandimprovementof. waveform,Peripheralperfusion,Preload全身麻酔薬投與による末梢灌流指標(biāo)（PI）と脈波変動(dòng)指標(biāo)〒173-8605東板橋區(qū)加賀2-11-（病院）:03-3964-1211（PHS（醫(yī)局）:03-3964-FAX（醫(yī)局）:03-3963-E-mail:7（マシモ社製、米國(guó)）は、経皮的動(dòng)脈血酸素飽和度測(cè)定裝置の指先脈波の解析から末梢灌流指標(biāo)（PerfusionIndexPI）及荷の評(píng)価が可能な醫(yī)療機(jī)器である。今回、全身麻酔薬投與によるPIとPVI10ml/kg/