Pitfall of bispectral index during intraoperative seizure -a case report-

Abstract

We report a case of a 42-year-old male who developed generalized tonic-clonic seizure with sudden, brief decrease in bispectral index (BIS) value while undergoing emergency kidney transplantation. Few reports have been made on intraoperative pitfall of BIS value associated with seizure. This case report suggests seizure should be taken into account as a reason for such brief fall of BIS, especially while under general anesthesia or in other specific cases in which clinical signs of seizure are unseen.

Color density spectral array of bilateral bispectral index system: Electroencephalographic correlate in comatose patients with nonconvulsive status epilepticus

“…In recent years, the BIS has increased its use in the NICUs, not only for sedation monitoring [18,19], but also for other areas such as early detection of brain death [20,21] or prediction of neurological outcome [22,23]. In epilepsy, only a few cases have been previously described, reporting abrupt changes in the number of BIS during seizures, with conflicting results [8,[24][25][26][27]. It seems that BIS value is notably influenced by EMG activity and, therefore, its utility for prolonged monitoring is limited.…”

Intraoperative seizures during redo cranioplasty for sinking skin flap syndrome- Role of BIS™ monitor in detection

“…[ 3 ] Literature shows BIS™ monitor being successful in detecting both the clinical and subclinical seizures showing marked fluctuation in the waveform and a varied pattern. [ 2 ] During seizures, signal quality index in our case remained between 80 and 85 ruling out any electrical and signal interference which could have affected the value on BIS monitor.…”

Multi-drug therapy for epilepsy influenced bispectral index after a bolus propofol administration without affecting propofol’s pharmacokinetics: a prospective cohort study

“…Epilepsy attacks obviously induce EEG changes; however, there have been few reports about the abnormal BIS values observed in patients with epilepsy. In addition, there have reports about both increases 26,27 and decreases in the BIS during seizures [28][29][30] , so the changes in the BIS seen during seizures remain unclear. In our study, most patients had well-controlled epilepsy, but some patients suffered regular small seizures.…”