Name: drug-induced sleep endoscopy (dise) with target controlled infusion (tci) and bispectral analysis in obstructive sleep apnea
Uploaded: 2016-12-06T12:30:00
Description: Watch this Scientific Journal Video about Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea at JoVE.com

The authors are grateful to Philipp Grundtner for his help with the statistical analyses.

该协议遵循弗里德里希 - 亚历山大大学埃尔兰根 - 纽伦堡（FAU）的当地伦理委员会的指导方针。 1. DISE-TCI-双谱分析程序<ol><li>执行静脉穿刺，并放置一个输液导管在患者左后卫的手或肘正中静脉，获得静脉通道来管理镇静剂。 </li><li>开展在室温（22℃）的调查。 </li><li>使清醒病人进入手术室。放置在患者中的手术台上仰卧位。 </li><li>在此之后，有麻醉师连接的生命体征监控系统。监测由?...

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自发睡眠时采用灵活的光纤rhinopharyngolaryngoscopy检测阻塞的部位最初的实验被描述为早在20世纪70年代22。然而，这种调查技术的根源最初纯粹是描述性的病理生理性的。在建立手术技术来治疗OSA，诸如悬雍垂腭咽成形（UPPP）由藤田，有人，然而，示出了操作的成功显然依赖于患者23术前仔细选择。在1991年引入药物诱导睡眠内镜（DISE）由普林格尔克罗夫特导致患者选择的第一次客观...

阻塞性睡眠呼吸暂停（OSA）的特征在于完整（呼吸暂停）或者上呼吸道在睡眠时的部分（低通气）崩溃的重复阶段。这些阶段往往是动脉氧饱和度下降而造成睡眠觉醒的碎片有关。 OSA用在一般人群中伴随白天症状发病率为3 -男性7％和2 -在妇女1 5％。中至重度OSA治疗中度的金标准是经鼻持续气道正压通气（nCPAP），其合规性是国际上报道的约40 - 60％2。该处理用于通过29 - OSA患者的83％，定期为小于4小时3。关于双方CPAP使用的长期合规正面和负面的预测都很好时下4闻名。此外，情感和临床副作用往往大大降低合规性。替代治疗方案，例如上呼吸道手术日erefore发挥OSA治疗中起重要作用。然而，事实上，手术（响应速度）的成功率比较低与通气治疗的比较是有问题的5,6。 人们希望，在1991年引进的睡眠内窥镜用克罗夫特和普林格尔不仅能够进一步深入了解OSA的病理生理机制也可能通过提高个体化手术治疗7响应速度。早在2011年，德维托等人的研究。展示了使用基于靶控输注（TCI）并相对于安全性，稳定性和精度8双频分析调查技术的优点。在此期间，睡眠内镜检查的有效性和可靠性已经建立，自从2014年欧洲立场文件，它是走向规范化9-11上。本研究的目的是建立用于睡眠endoscop的标准化协议ý由镇静异丙酚靶控输注，具有镇静的使用双频分析深度的实时监测相结合，以便根据OSA-严重性分化障碍图案。 病例报告： 学习规划： 回顾性研究是在耳鼻咽喉 - 弗里德里希 - 亚历山大大学埃尔兰根 - 纽伦堡头颈外科部2012年9月和2014年11月间进行，之后由当地伦理委员会的批准。所有参赛57例，年龄20〜73岁，被耳鼻咽喉，头颈外科部招聘。 52例患者男5女。除了标准化的采访中，他们被一个耳鼻喉科检查，并接受了胃镜检查清醒评估上呼吸道。然后心肺多导睡眠图是在该部进行的睡眠实验室，使他们的睡眠呼吸障碍的准确分类。该OSA的严重程度分为轻度（AHI 5 - 15 /小时），中度（AHI&gt; 15 &lt;30 /小时）或重度（AHI&gt; 30 /小时），根据睡眠医学任务的美国学院的标准部队12 。成立于上呼吸道（主要指示）的一个计划手术干预的情况下，或在应用nCPAP违约（仲或佐剂指示）的情况下，为睡眠内窥镜的指示。 这项研究的入选标准是男性和女性年龄在18 - 75岁被诊断为多导睡眠监测轻度，中度或重度OSA。排除标准是麻醉医师的美国社会分类（ASA）IV / V，中枢性呼吸暂停，镇静剂，酒精或毒品上瘾，过敏异丙酚，孕妇误用积极的历史。 诊断，评估和计划： 汽车diorespiratory多导睡眠图（PSG）： 多导睡眠图用一个33通道心肺诊断系统进行的。对于多导睡眠监测诊断技术的过程中使用脑电图标准化技术遵循睡眠医学的美国学院（AASM）的建议（EEG; F4-M1，C4-M1，O2-M1），左右眼电图，颏和胫肌，鼻压力插管，胸腹呼吸努力传感器（感应体积描记器），体位传感器，脉搏血氧饱和度，打鼾麦克风的肌电，一个通道ECG和一个红外录像13。评价是根据AASM标准进行（2.0版，2012）和由德国睡眠学会（DGSM）13，14的认可的医疗睡眠专家进行。多导睡眠图证实OSA后，所有57例患者接受了标准化的异丙酚基于药物引起的石勒EP内窥镜（DISE）与TCI和双频谱分析（DISE-TCI-双频谱分析）。 术前准备： 由于肌肉松弛作用，与苯二氮没有在术前用药仅用于诊断目的而进行的睡眠内镜检查的情况下，被赋予。如果有计划外科手术过程中进行睡眠内窥镜，用可乐定为前用药为苯并二氮类的替代，考虑相应的禁忌考虑。 梗阻的分类： 投票系统用于分类目的15。梗阻以下站点被认为是：帆，口咽（横向口咽墙，扁桃体），舌根和会厌。梗阻严重程度分为三个档次（无阻碍;部分和完全性肠梗阻）。梗阻的配置被分为前，后erior，横向和同心。 靶控输注（TCI）： 靶控输注（TCI）描述了使用Microchip控制输液泵来实现血液中的目标浓度药物输液。该方法的目的是迅速实现和根据指定的（定义）的血浆水平，或在效应部位的TCI的情况下的效果的水平有一定的效果（ 例如，镇静）的维护。血浆水平或效应部位水平的计算是基于药物动力学3-隔室模型（根据沼泽或Schnider）使用在志愿者人口16-18所确定的药理半衰期值和分配系数。快速达到并保持在等离子体异丙酚指定的目标水平所需的输注率然后自动计算并通过输液泵来控制。本研究使用由输注泵的系统和一个数据马nager与沼泽的预编程的药代动力学模型在一起。镇静的目标深度同时被双谱分析监测。 双频分析： 双频分析/索引与大脑中的电活动密切相关。的双频分析记录在监视器额叶EEG信号，并与各种专有算法的帮助下，分析了脑电功率谱的分布。的脑电双频指数是0和100 19之间的无量纲数。在一般情况下，大约90的值反映了高频的β-波的优势，并表明病人清醒。低于10双频分析值表示脑电图抑制20，21的。因此，这种规模提供了镇静剂的对大脑的效果的间接测量。为了维持麻醉的足够深度，避免患者的不希望的术地区分清醒，一个BISP推荐的&lt;60 ectral指数。另一方面，应该避免的&lt;40的双频指数的值，以防止不必要的深度麻醉。 所有的睡眠内窥镜检查是由两名经验丰富的耳鼻咽喉科的顾问，在睡眠医学附加资格（TM 59.6％（57分之34），AF 40.4％（57分之23）进行。

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			<td height="20" style="height:20px;width:387px;">Cardiorespiratory polysomnography&#160;</td>
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			<td height="20" style="height:20px;">SOMNOscreen&#160;</td>
			<td>SOMNOmedics, Randersacker, Germany</td>
			<td>SBT202</td>
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			<td height="20" style="height:20px;">Propofol-Lipuro 20 mg/mL; 2,6-diisopropylphenol</td>
			<td>B. Braun Melsungen AG, Melsungen, Germany</td>
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			<td height="20" style="height:20px;">Infusion pump Orchestra Module DPS Visio</td>
			<td>Fresenius Kabi, Germany GmbH&#160;</td>
			<td>Z082420</td>
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			<td height="20" style="height:20px;">Data manager Orchestra Base Primea</td>
			<td>Fresenius Kabi Germany GmbH</td>
			<td>Z081320</td>
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		<tr height="20">
			<td height="20" style="height:20px;">Bispectral analysis (BIS)</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">BIS single-use electrode BIS Quatro Sensor</td>
			<td>Covidien, Neustadt/Donau, Germany GmbH</td>
			<td>186-0106</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">BIS monitor BIS VISTA</td>
			<td>Covidien, Neustadt/Donau, Germany GmbH</td>
			<td>186-0210</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Endoscope&#160;</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Laryngo fiberscope, length 30 cm, diameter 3.5 mm</td>
			<td>KARL STORZ GmbH &#38; Co. KG, Tuttlingen, Germany</td>
			<td>11101RP</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Picture Archiving&#160; System&#160;</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:387px;">AIDA</td>
			<td>Karl STORZ GmbH &#38; Co. KG, Tuttlingen, Germany</td>
			<td>WD 200-XX</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:387px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:387px;">Premedication&#160;</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Catapresan; Clonidin-HCl 0.075 mg/0.15 mg/0.3 mg</td>
			<td>Boehringer Ingelheim Pharma, GmbH &#38; Co. KG, Ingelheim am Rhein, Germany</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

drug-induced sleep endoscopy (dise) with target controlled infusion (tci) and bispectral analysis in obstructive sleep apnea

这项研究的目的是要建立药物诱导睡眠内镜（DISE）的标准化协议来区分阻塞性睡眠呼吸暂停（OSA）阻塞模式。镇静异丙酚靶控输注（TCI）与镇静使用双频分析深度的实时监测相结合。 在一项观察性研究57例患者（平均年龄44.8年，±SD 10.5;平均呼吸暂停低通气指数（AHI）30.8 /小时，±SD 21.6，平均BMI28.2千克/米2，±SD 5.3）进行心肺多导睡眠监测，然后用DISE TCI和双频分析。睡眠通过用一个TCI-泵异丙酚的静脉滴注单独诱导，用2.0微克/毫升的初始目标血浆水平。根据连续监测病人的呼吸，意识和双频分析的价值状态，目标血浆丙泊酚水平在0.2微克/毫升/ 2分钟的步上升，直到德镇静sired深度为止。在镇静的目标深度脑电双频分析的平均值确定和DISE-TCI-双频谱分析过程中受阻的模式，然后根据投票系统分类。随后对结果进行按多导睡眠监测和人体测量数据进行分析。在所有学位OSA的严重阻碍多部位发生澄清了之前的上呼吸道手术睡眠内窥镜的需要。 该技术的优点是协议即使对于患者异质群体的再现性。此外，与双频指数的实时控制异丙酚的血浆水平的逐渐受控，标准化增加导致镇静的精确控制的深度。该DISE-TCI-双频谱分析过程是对睡眠内窥镜的需要可重复的协议的一个步骤 - 能够标准化。但它是尚未公知的瓦特论是这些观察到的阻塞模式也对应于自然睡眠的调查结果。

<html>患者特性示于表1中 。在镇静的期望深度的双频分析的平均值为60（±SD 10.4，范围35 - 80; 95％置信区间42.0 - 47.6）。阻塞的单个或多个组合的各网站上OSA严重程度的各个层面被发现。梗阻确定的地点，频率递减的顺序，分别为：内膜59.6％（五十七分之三十四），舌根43.9％（57分之25），口咽42.1％（57分之24），或在会厌29.8％的水平（57分之17）。软腭或口?...

Watch this Scientific Journal Video about Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea at JoVE.com

Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea

这项研究的目的是要建立睡眠内窥镜来区分阻塞性睡眠呼吸暂停（OSA）阻塞模式的标准化协议。镇静的靶控输注（TCI）与镇静使用双频分析深度的实时监测相结合。

药物引起的与靶控输注（TCI）和双频分析阻塞性睡眠呼吸暂停睡眠内窥镜（DISE）

The aim of this study was to establish a standardized protocol for drug-induced sleep endoscopy (DISE) to differentiate obstruction patterns in ...

Research

JoVE Journal

Medicine

Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea

A Novel Capsulorhexis Technique Using Shearing Forces with Cystotome

一种新型撕囊技术，使用剪切力与Cystotome

Purpose:
To demonstrate a capsulorhexis technique using predominantly shearing forces with a cystotome on a virtual reality simulator and on a human eye....

科研

医学

A Novel Technique of Rescuing Capsulorhexis Radial Tear-out using a Cystotome

径向的抢救囊撕式的新技术，使用一个Cystotome

Part 1 : Purpose:   To demonstrate a capsulorhexis radial tear out rescue technique using a cystotome on a virtual reality cataract surgery simulator and ...

Bronchial Thermoplasty:  A Novel Therapeutic Approach to Severe Asthma

支气管Thermoplasty：严重哮喘的一种新的治疗方法

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled ...

Evaluation of Respiratory Muscle Activation Using Respiratory Motor Control Assessment (RMCA) in Individuals with Chronic Spinal Cord Injury

Evaluation of Respiratory Muscle Activation Using Respiratory Motor Control Assessment RMCA in Individuals with Chronic Spinal Cord Injury

评价呼吸肌慢性脊髓损伤个人使用呼吸电机控制评估（RMCA）

During breathing, activation of respiratory muscles is coordinated by integrated input from the brain, brainstem, and spinal cord. When this coordination ...

Dried Blood Spot Collection of Health Biomarkers to Maximize Participation in Population Studies

干生生物标志物的血斑收藏最大限度地参与人口研究

Biomarkers are directly-measured biological indicators of disease, health, exposures, or other biological information. In population and social sciences, ...

Assessing Changes in Volatile General Anesthetic Sensitivity of Mice after Local or Systemic Pharmacological Intervention

局部或全身药物干预后评估的变化小鼠中挥发性全身麻醉药敏感性

One desirable endpoint of general anesthesia is  the state of unconsciousness, also known as hypnosis. Defining the hypnotic state in animals is  less ...

Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery

左心房，主动脉和肺动脉的超声心动图小鼠

The present methodology teaches the investigator how to measure and use the LAV as a surrogate of chronic elevations in Left Ventricular diastolic ...

In Vivo Evaluation of the Mechanical and Viscoelastic Properties of the Rat Tongue

In Vivo Evaluation of the Mechanical and Viscoelastic Properties of the Rat Tongue

大鼠舌的机械和粘弹性的体内评估

The tongue is a highly innervated and vascularized muscle hydrostat on the floor of the mouth of most vertebrates. Its primary functions include ...

Multi-Modal Home Sleep Monitoring in Older Adults

老年人多式家庭睡眠监测

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and ...

A Rat Carotid Artery Pressure-Controlled Segmental Balloon Injury with Periadventitial Therapeutic Application

大鼠胡萝卜动脉压力控制段气球损伤与腹腔ventit 治疗应用

Cardiovascular disease remains the leading cause of death and disability worldwide, in part due to atherosclerosis. Atherosclerotic plaque narrows the ...