Effect of sugammadex or neostigmine neuromuscular block reversal on bispectral index monitoring of propofol/remifentanil anaesthesia

Abstract

We have shown that reversal of NMB with sugammadex or neostigmine increased BIS values dependent on the presence of EMG activity. Thus, the effect of muscle activity reappearance during rocuronium NMB reversal spuriously increasing the BIS value should be taken into consideration when relying on BIS monitoring for evaluating propofol/remifentanil recovery.

Impact of Bispectral Index for monitoring propofol remifentanil anaesthesia. A randomised clinical trial

“…suggests that a sufficient depth of anaesthesia was achieved in all patients. However, the presence of electromyographic muscular activity is a known confounder for the functioning of the BIS monitor, 10 and it could explain the relatively high values of BIS in the paediatric population. The main objective of the study was to investigate the clinical utility of the use of BIS in a department of anaesthesia using TIVA with propofol and remifentanil.…”

“…Before study start, we produced 252 sealed opaque envelopes, each containing an individual project identification code for each patient that will be included (Age group -Operation subgroup -Arm BIS/control -Sequential number [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The envelopes were coded and subdivided according to the stratification planned for the study (Age -Operation type), resulting in nine groups of 28 envelopes each.…”

Sugammadex: A Review of Neuromuscular Blockade Reversal

“…While a significant (p \ 0.05 vs. baseline) increase in BIS values was seen following administration of sugammadex 4 mg/kg to patients with high electromyographic activity during stable propofol and remifentanil anaesthesia, this reflected muscle activity reappearance, rather than consciousness [14].…”

Response of bispectral index to neuromuscular block in awake volunteers

“…When EMG activity decreases, BIS also decreases regardless of whether it is a result of more anaesthetic agent or NMBDs alone. [8][9][10][11][12][13][14][15] Given that the patients in these studies were known to be anaesthetized, this has been interpreted to mean that the EMG is simply 'noise' that interferes with the BIS algorithm causing it to be 'falsely elevated'. [12][13][14][15][16] However, without clear evidence of how the BIS responds to the EMG in awake subjects, this conclusion is premature.…”