Bispectral Analysis Measures Sedation and Memory Effects of Propofol, Midazolam, Isoflurane, and Alfentanil in Healthy Volunteers

Glass, Peter S. A.; Bloom, Marc; Kearse, Lee A.; Rosow, Carl E.; Sebel, Peter S.; Manberg, Paul J.

doi:10.1097/00132586-199808000-00057

Cited by 139 publications

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“…These reports suggest that BIS levels correlate well with depth of sedation [4,5]. Only a few investigators have studied the validity of BIS monitoring in ICU patients, but a correlation between BIS levels and sedation scales in ICU patients has been reported for various agents [6,7].…”

Section: Introductionmentioning

confidence: 99%

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et al. 2003

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Correspondence: Dilek Memis ², dilmemis@mynet.com R123 APACHE = Acute Physiology and Chronic Health Evaluation; BIS = bispectral index; ICU = intensive care unit. AbstractIntroduction In intensive care unit patients we assessed, using bispectral index (BIS) monitoring, whether the addition of magnesium sulphate infusion could decrease the sufentanil infusion required to maintain sedation. Patients and methods A total of 30 adult patients who were expected to require machanical ventilation for 6 hours in the intensive care unit were randomly assigned to receive either sufentanil infusion or sufentanil plus magnesium infusion. We monitored BIS levels continously. BIS levels in the range 61-88 are required to maintain a state of sedation, and in both groups BIS levels were kept within this range by increasing or decreasing the sufentanil infusion. Hourly consumption of sufentanil was monitored. Cardiovascular, respiratory and biochemical data were recorded. Results There was no significant difference between the groups with respect to cardiovascular, respiratory and biochemical parameters. Magnesium infusion, when added to sufentanil infusion, decreased the consumption of sufentanil at all times accept during the first hour (P < 0.001). There was no significant difference in BIS values between the groups (P > 0.05). Conclusion This is the first clinical study to demonstrate that magnesium sulphate infusion decreases sufentanil requirements. Because of the limited number of patients included and the short period of observation, our findings must be confirmed by larger clinical trials of magnesium infusion titrated to achieve prespecified levels of sedation. Furthermore, randomized clinical studies are needed to determine the effects of magnesium infusion on opioids.

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Section: Introductionmentioning

confidence: 99%

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et al. 2003

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“…For various agents (e.g. propofol and midazolam) it has been shown that the BIS may correlate with dose-dependent levels of anaesthesia [10,12-14] and ICU sedation [15-18]. Level of sedation and changes in memory function correlated well with BIS in volunteers [19].…”

Section: Introductionmentioning

confidence: 99%

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et al. 2005

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Introduction Most clinicians give sedatives and analgesics according to their professional experience and the patient's estimated need for sedation. However, this approach is prone to error. Inadequate monitoring of sedation and analgesia may contribute to adverse outcomes and complications. With this in mind, data obtained continuously using nonstimulating methods such as bispectral index (BIS) may have benefits in comparison with clinical monitoring of sedation. The aim of this prospective observational trial was to evaluate the use of electroencephalographic (EEG) BIS for monitoring sedation in paediatric intensive care unit (PICU) patients. Methods Forty paediatric patients (<18 years) were sedated for mechanical ventilation in a cardiac surgical and general PICU. In each paediatric patient BIS and COMFORT score were obtained. The study protocol did not influence ongoing PICU therapy. BIS and corresponding COMFORT score were collected three times for each patient. Measurements with the best starting EEG impedances were analyzed further. Deep sedation was defined as a COMFORT score between 8 and 16, and light sedation as a score between 17 and 26. Biometric and physiological data, and Pediatric Risk of Mortality III scores were also recorded. Results There was a good correlation (Spearman's rho 0.651; P = 0.001) between BIS and COMFORT score in the presence of deep sedation and low starting impedance. Receiver operating characteristic (ROC) analysis revealed best discrimination between deep and light sedation at a BIS level of 83. Conclusion In the presence of deep sedation, BIS correlated satisfactorily with COMFORT score results if low EEG impedances were guaranteed.

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“…Administration of large doses of analgesic/sedative/anaesthetic agents once the withdrawal/dying process was initiated would achieve this latter goal and could be accommodated within the law if titrated against neurological monitoring modalities. 89 It is difficult to predict, however, the professional and public response to this, one interpretation being that public confidence would increase with the knowledge that even with rapid procurement, practitioners could guarantee freedom from awareness and any suffering, and indeed, bring an inevitable death to a swifter conclusion. The alternative interpretation of practitioners becoming engaged in a process close to euthanasia may actually engender even more distrust.…”

Section: Discussionmentioning

confidence: 99%

Non-heart beating organ donation: old procurement strategy—new ethical problems

Bell

2003

J Med Ethics

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The imbalance between supply of organs for transplantation and demand for them is widening. Although the current international drive to re-establish procurement via non-heart beating organ donation/donor (NHBOD) is founded therefore on necessity, the process may constitute a desirable outcome for patient and family when progression to brain stem death (BSD) does not occur and conventional organ retrieval from the beating heart donor is thereby prevented. The literature accounts of this practice, however, raise concerns that risk jeopardising professional and public confidence in the broader transplant programme. This article focuses on these clinical, ethical, and legal issues in the context of other approaches aimed at increasing donor numbers. The feasibility of introducing such an initiative will hinge on the ability to reassure patients, families, attendant staff, professional bodies, the wider public, law enforcement agencies, and the media that practitioners are working within explicit guidelines which are both ethically and legally defensible.

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Bispectral Analysis Measures Sedation and Memory Effects of Propofol, Midazolam, Isoflurane, and Alfentanil in Healthy Volunteers

Cited by 139 publications

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Non-heart beating organ donation: old procurement strategy—new ethical problems

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