Overestimation of Bispectral Index in Sedated Intensive Care Unit Patients Revealed by Administration of Muscle Relaxant

Vivien, Benoît; Maria, Sophie Di; Ouattara, Alexandre; Langeron, Olivier; Coriat, Pierre; Riou, Bruno

doi:10.1097/00000542-200307000-00006

Cited by 237 publications

(142 citation statements)

References 38 publications

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“…Humans sedated or anaesthetized with propofol alone also have higher BIS values than when propofol is administered in conjunction with a non-depolarizing muscle relaxant. These higher values have been attributed to electromyographic (EMG) activity that Laboratory Animals (2006) 40 falsely increases the BIS value (Bruhn et al 2000, Vivien et al 2003.…”

Section: Resultsmentioning

confidence: 99%

Relationship of bispectral index values, haemodynamic changes and recovery times during sevoflurane or propofol anaesthesia in rabbits

et al. 2006

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SummaryThe aim of this study was to determine and compare the degree of hypnosis achieved during propofol or sevoflurane anaesthesia in rabbits using bispectral index (BIS), and to evaluate its usefulness as a predictor of both haemodynamic changes during anaesthesia and recovery times. Twenty adult male New Zealand White rabbits, average weight 4.470.4 kg, were used for this study. Animals were randomly allocated to one of two groups with 10 rabbits/group. An electroencephalographic recording was obtained from each conscious rabbit prior to drug administration. All animals received buprenorphine as a preanaesthetic medication (0.05 mg/kg, intravenous [i.v.]). Anaesthesia was induced with propofol (8 mg/kg, i.v.) in all animals; 10 rabbits were maintained with sevoflurane via inhalation (1 minimum alveolar concentration -end-tidal sevoflurane concentration of 3.7% -at a fresh gas flow rate of 3 L/ min; group I), and 10 were maintained with i.v. propofol (0.6 mg/kg/min; group II). The rabbits were orotracheally intubated and spontaneous ventilation was maintained throughout the study (100% oxygen). After abdominal surgery through a ventral midline laparotomy, rabbits were allowed to recover from anaesthesia. Cardiovascular variables and BIS values were recorded at intervals throughout the procedure, as was the duration of recovery from anaesthesia.In both groups, mean BIS values were significantly decreased immediately after induction, compared with baseline values obtained during consciousness. Anaesthetic depth (evaluated by clinical observation) was similar in both groups; however, group II rabbits had significantly higher (Po0.001) BIS values from 30 s before incision until anaesthesia was discontinued. There was no significant difference in BIS recorded 1 and 5 min after incision as compared with values obtained 30 s before incision in either group.During sevoflurane or propofol administration, correlations were found between BIS values and mean arterial blood pressure (MABP), and between BIS values and heart rate (HR).Mean BIS values at discontinuation of administration of the anaesthetic agent were greater in group II (69.176.0) than in group I (49.372.2). However, recovery from anaesthesia was significantly longer in group II (38.477.2 min) than in group I (11.572.5 min).In conclusion, BIS can be used to differentiate between conscious and unconscious states during anaesthesia in rabbits. BIS values derived from an electroencephalogram at the end of anaesthesia were not useful for predicting the speed of anaesthetic recovery in sevoflurane or propofol-anaesthetized rabbits undergoing abdominal surgery. Despite the correlation found Correspondence: Marı´a Fernanda Martı´n Cancho, Minimally

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Section: Resultsmentioning

confidence: 99%

Relationship of bispectral index values, haemodynamic changes and recovery times during sevoflurane or propofol anaesthesia in rabbits

et al. 2006

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“…18 When non-paralyzed patients received sedation in an intensive care unit, use of the BIS to guide administration of midazolam exposed the patients to "unnecessary oversedation." 19 Thus, it would appear that in spontaneously breathing patients, the EMGrelated "contamination" of the BIS value eliminates the beneficial effects of BIS monitoring in improving the titration of the maintenance volatile anesthetic.…”

Section: Discussionmentioning

confidence: 99%

Bispectral index monitoring does not improve early recovery of geriatric outpatients undergoing brief surgical procedures

Zohar

Luban

White

et al. 2006

Can J Anesth/J Can Anesth

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Purpose:To assess if titration of sevoflurane using the bispectral index (BIS) monitor improves the early and intermediate recovery in geriatric outpatients undergoing brief urologic procedures under general anesthesia without muscle relaxants. Methods:After a standardized induction with propofol and fentanyl, a laryngeal mask airway was inserted and sevoflurane was administered in combination with 60% nitrous oxide in oxygen for maintenance of anesthesia in spontaneously breathing outpatients. In the Control group (n = 25), sevoflurane and fentanyl were titrated according to standard clinical practice. In the BISdirected group (n = 25), sevoflurane was titrated to maintain a BIS value between 50 and 60, and supplemental fentanyl, 25 µg iv boluses were administered to treat tachypnea. The intraoperative anesthetic and analgesic requirements, as well as the times to eye opening, removal of the laryngeal mask airway device, response to simple commands, orientation to person and place, and postanesthesia care unit discharge eligibility (fast-track score of 14) were assessed at specific time intervals. Results:The minimum alveolar concentration-hour of sevoflurane (0.25 ± 0.15 and 0.31 ± 0.2) and end-tidal concentrations of sevoflurane at the end of surgery (0.3 ± 0.3 and 0.4 ± 0.20%) did not differ significantly between the Control and BIS-directed groups, respectively. Although the percentage of patients requiring supplemental boluses of fentanyl was reduced in the BISdirected group (16 vs 48%, P <0.05), the intraoperative BIS values and recovery times were similar in the two groups. Conclusion:In this non-paralyzed elderly outpatient surgery population, the use of BIS monitoring for titrating the maintenance anesthetic (sevoflurane) failed to improve the early recovery process. (0,25 ± 0,15 et 0,31 ± 0,2) et les concentrations télé-expiratoires de fin d'opération (0,3 ± 0,3 et 0,4 ± 0,20 %) Objectif

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“…Although bispectral index monitoring has been evaluated for conscious sedation, results to date for this indication have been variable. 25,26 In conclusion, we have demonstrated that a remifentanil technique combining a basal infusion and PCA boluses and propofol target infusion were adequate, but not optimal techniques for RF ablation.…”

Section: Discussionmentioning

confidence: 84%

Remifentanilversus propofol for radio frequency treatment of atrial flutter

Lena

Mariottini

Balarac

et al. 2006

Can J Anesth/J Can Anesth

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Overestimation of Bispectral Index in Sedated Intensive Care Unit Patients Revealed by Administration of Muscle Relaxant

Cited by 237 publications

References 38 publications

Relationship of bispectral index values, haemodynamic changes and recovery times during sevoflurane or propofol anaesthesia in rabbits

Relationship of bispectral index values, haemodynamic changes and recovery times during sevoflurane or propofol anaesthesia in rabbits

Bispectral index monitoring does not improve early recovery of geriatric outpatients undergoing brief surgical procedures

Remifentanilversus propofol for radio frequency treatment of atrial flutter

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