Abstract
BackgroundThe bispectoral index (BIS), a parameter derived from electroencephalogram, has been used to assess the depth of anesthesia. The objectives of this study were to evaluate the effect of BIS monitoring on sevoflurane consumption and recovery profile at the end of anesthesia. After obtaining Institutional Review Board approval and written informed consent, 25 American Society of Anesthesiologists (ASA) physical status classification 1 and 2 patients undergoing breast cancer surgeries who had BIS monitoring in addition to standard ASA monitoring (BIS GROUP) were compared against 25 controls (control group). In the control group, adequate depth of anesthesia was maintained using routine clinical parameters like heart rate (HR), mean arterial pressure (MAP), and minimum alveolar concentration (MAC) of sevoflurane, while in the BIS group, it was maintained by keeping the BIS score between 40 and 60 (mean 50). Data including demographics, sevoflurane consumption, hemodynamic variables, and recovery profile at the end of anesthesia was assessed in terms of time for eye opening (TEO), time for motor response (TMR), time for extubation (TE), and modified Aldrete scoring (MAS).ResultsThe mean sevoflurane consumption was lower (P = 0.019) in the BIS group. TEO (P = 0.001), TMR (P = 0.0001), and TE (0.003) were shorter in the BIS group. Difference in MAS between the 2 groups was not statistically significant (P = 0.085).ConclusionsBIS monitoring during anesthesia resulted in significant reduction in the sevoflurane consumption. Patients who had BIS monitoring awoke earlier and had better recovery profile at the end of anesthesia.
Highlights
The bispectoral index (BIS), a parameter derived from electroencephalogram, has been used to assess the depth of anesthesia
A total of 55 patients were enrolled in the study, among which three patients were removed as two of them did not meet the inclusion criteria of the study and one patient refused to participate in the study
52 patients were allocated and divided into 2 groups (BIS group and control group), among which one patient from BIS group was lost to follow-up as intervention was discontinued due to prolonged duration of surgery and one patient from the control group was lost to follow-up due to technical failure to collect data, and so the final analysis was made from 50 patients (Fig. 1)
Summary
The bispectoral index (BIS), a parameter derived from electroencephalogram, has been used to assess the depth of anesthesia. Despite remarkable improvements in the assessment of the cardiovascular and respiratory system changes during anesthesia, the impact of inhalational agents on central nervous system and its functioning always remained as a challenge This led to the emergence of electroencephalography (EEG)-based indices like bispectoral index (BIS) monitor to assess the depth of anesthesia. BIS monitoring may act as an additional vital sign that allows the clinicians to deliver anesthesia in keeping with the patients need and to assess and respond befittingly to the patient’s clinical condition during surgery It is very useful for the titration of volatile anesthetic agents more precisely than what is possible by routine clinical parameters (Shafiq et al, 2012)
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