Bispectral Index Analysis Research Articles

COMPARATIVE STUDY OF PROPOFOL AUTO-COINDUCTION VERSUS KETAMINE PROPOFOL COINDUCTION USING PRIMING PRINCIPLE BY BISPECTRAL INDEX ANALYSIS FOR DAY CARE SURGERY

Aim:The aim of our study was to do the comparison of Propofol Auto-coinduction versus Ketamine Propofol coinduction using priming principle by bispectral index analysis for day care surgery. Methods:150 patients participated in our study at Govt. Medical College and Rajindra Hospital, Patiala. Patients aged above 18 years and ASA Grade I and II scheduled to undergo elective surgery were included in this prospective, randomized controlled trial. All patients were randomly assigned into 3 groups of 50 each. Group A- patients were given Propofol 0.5mg/kg body wt., Group B- patients were given Ketamine 0.5mg/kg body wt., Group C- patients were given normal saline 2.5ml 2 minutes before induction. Patients were induced with injection Propofol 1% at rate of 30mg/10 sec until BIS value reaches to 40. Induction dose requirements of Propofol, Haemodynamic parameters including HR, MAP, SBP, DBP,SPO2, ECG, RR were recorded. Incidence of post op complications / side effects were also recorded. Data was tabulated and subjected to statistical analysis. Results: Groups were comparable to each other with respect to age, weight, gender, ASA status. Significant difference was found in HR, SBP, DBP between Group A and Group B at 1 minute and 2 minute after coinduction. MAP shows statistically highly significant (p < 0.001) results after 1minute and 2 minute of coinduction. Total dose of propofol required and mean BIS value shows highly significant results when compared between groups. Conclusion: In conclusion, our study identified that overall dosage of propofol was significantly lower when modest doses of propofol and ketamine were given beforehand than when a placebo was used. When used as an induction agent, ketamine offers better haemodynamic stability.

Bispectral index analysis in general anesthesia: An observational study

Introduction: Bispectral index monitoring (BIS) is one of the major techniques used in monitoring depth of anesthesia. The present study was carried out to observe the changes in BIS values vis-a-vis the changes in hemodynamic parameters during the standard general anaesthesia practices in our institute. Materials and Methods: This prospective observational study was carried out in 50 ASA I/II elective surgeries in adults under general anesthesia. Conditions and drugs likely to interfere with BIS values were excluded. Anesthesia protocol was kept uniform. Patients were induced with IV propofol 2mg/kg, IV pentazocine 0.5mg /kg and IV vecuronium 0.1mg/kg. Patients were intubated with appropopriate size endotracheal tube and oxygen, nitrous oxide, halothane and vecuronium were used for maintanence of anesthesia. Patients were reversed with IV neostigmine 0.05mg/kg and I V Atropine 20mcg/kg. The BIS values, hemodymanic changes, recovery characteristics (including awareness) were noted. Correlation between BIS scores and hemodynamic parameters was assessed. Results: There were predictable changes in BIS scores with the standard anesthesia technique followed in the present study. Similarly, hemodynamic changes were also on the expected lines during the course of anesthesia. However, the correlation between BIS score and hemodynamics could not be established. Conclusion: Bispectral Index Monitor is a useful tool to assess the depth of anesthesia in standard anesthetic management. Alterations in anesthetic management and drug dosages can be guided by BIS scores. Cost factor and the need to use updated and refined versions of the software are the possible limitations. Keywords: Electroencephalography, Consciousness monitors, Anesthesia, General, Hemodynamics.

Awake non-intubated pulmonary metastasectomy

Background: Pulmonary metastasectomy has been progressively considered a procedure feasible through a thoracoscopic approach under awake non-intubated anesthesia. Methods: Since 2000 we established the program named “Awake Thoracic Surgery Research” under the guidance of Prof. Tommaso Claudio Mineo. To our knowledge, this program is the first in the world to be created for this specific purpose. From the beginning until 2005 procedures were carried out in an awake patient under thoracic epidural anesthesia and triportal approach. From 2005 onwards we shifted to an intercostal blockade and sedation controlled by bispectral index analysis through an uniportal approach. Results: From 2000 to 2018 a total of 106 patients underwent lung metastasectomy: 14 with triportal and 92 with uniportal approach. Only 7 (6.6%) patients required the conversion to general anesthesia for intolerance of the procedure or technical difficulties. Median operative time was 31 [interquartile range, 23–53] minutes and a global in-operatory room stay was 51 [39–62] minutes per procedure. Multiportal video-assisted thoracic surgery (VATS) had a shorter operating time but compensated by the longer time for establishing effective thoracic epidural anesthesia. No mortality was documented. Major morbidity affected 6 patients (6.1%). Hospital stay was 3 [2–4] days. Not even in this case differences between group were evidenced. Overall survival at 3 years was 49%. No difference was correlated to the type of approach. Conclusions: Selection for awake non-intubated lung metastasectomy should include patients with peripheral oligometastases easy to palpate and small enough to be safely resected with a limited number of staple firing.

Bispectral index analysis during cardiac arrest and cardiopulmonary resuscitation in a propofol‐anesthetized calf

To describe bispectral index (BIS) findings and compare them with cardiovascular and respiratory trends during cardiac arrest and successful CPR in a propofol-anesthetized calf. A 3-month-old calf was anesthetized as part of a research project. A thromboxane analog drug (U46619) was administered IV to induce pulmonary hypertension. Within 10 minutes following U46619 administration, cardiac activity deteriorated, leading to asystole. At this point, BIS and suppression rate were 0 and 100, respectively. Anesthetic drug delivery was discontinued and external chest compressions were initiated. During CPR, end-tidal CO2 concentration decreased and BIS increased, but no spontaneous cardiac activity was noted, thus IV epinephrine was administered. Return of spontaneous circulation was achieved and systemic arterial hypertension developed, while BIS briefly decreased and then increased during the following 2 minutes. The calf's cardiopulmonary variables returned to physiological ranges within 10 minutes after the return of spontaneous circulation and remained stable. This is the first report in which BIS is documented together with standard monitoring techniques during cardiopulmonary arrest and resuscitation in a calf. BIS varied with cardiovascular performance, and may be indicative of cerebral blood flow in this context. Further research may be warranted to define the role of BIS for monitoring cerebral activity during CPR.

Hemodynamic and Bispectral Index Analysis of Admixtures of Propofol and Ketamine in Continuous Infusion Anesthetics for Adult Outpatient Dentoalveolar Surgery: A Prospective, Randomized, Placebo-Controlled Clinical Trial

Hemodynamic and Bispectral Index Analysis of Admixtures of Propofol and Ketamine in Continuous Infusion Anesthetics for Adult Outpatient Dentoalveolar Surgery: A Prospective, Randomized, Placebo-Controlled Clinical Trial

Bispectral Index Analysis of Opioid Immobilization of Rocky Mountain Elk

Abstract: We immobilized elk with either isoflurane to produce general anesthesia (control), 0.01 mg/kg carfentanil plus 0.1 mg/kg xylazine, or 0.25 mg/kg butorphanol plus 0.4 mg/kg azaperone plus 0.15 mg/kg medetomidine (BAM) and measured the bispectral index (BIS). The carfentanil‐xylazine BIS (70.4 + 1.4) and the BAM BIS (60.2 + 1.5) were higher than the control BIS (47.2 + 4.1; P ≤ 0.001). These data indicate that opioids produce neuroleptanalgesia and not general anesthesia or sedation, which explains observed elk responses to these drugs.

A comparison between bispectral index analysis and auditory-evoked potentials for monitoring the time to peak effect to calculate the plasma effect site equilibration rate constant of propofol

To the best of our knowledge, the value of the plasma effect site equilibration rate constant (k(e0)) of propofol has not been reported in Chinese patients. The aim of this prospective, randomized study was to examine the characteristics of the time to peak effect (T(PEAK)) of propofol, a pharmacokinetic-independent descriptor of blood-brain equilibration, and k(e0) derived from T(PEAK) with A-line auditory-evoked potential monitor and Aspect A-2000 bispectral index monitor in Chinese patients. Two-hundred ASA I patients received a submaximal bolus dose of propofol (1.5 mg kg(-1)). T(PEAK) was randomly measured by means of the A-line auditory-evoked potential monitor (Group AAI (auditory-evoked potential index), n = 100) or the Aspect A-2000 bispectral index monitor (Group BIS, n = 100). Using T(PEAK) and four previously validated pharmacokinetic parameter sets of propofol, the k(e0) was estimated according to a method proposed recently. The mean T(PEAK) was 145 +/- 35 s (50-224 s) and 74+/-24 s (38-143 s) in Groups AAI and BIS, respectively (P < 0.01 between groups). There were no correlations between the patient's age and T(PEAK)s (r = 0.147 and 0.031 for Groups AAI and BIS). The median k(e0) in Group AAI was 0.64 min(-1) with the model of Marsh, 0.17 min(-1) with the Schnider model, 0.78 min(-1) with the Tackley model and 0.93 min(-1) with the Shafer model. The median k(e0) in Group BIS was 1.87 min(-1) with the model of Marsh, 0.83 min(-1) with the Schnider model, 2.14 min(-1) with the Tackley model and 2.48 min(-1) with the Shafer model (P < 0.01 between groups and models). The T(PEAK) of propofol measured by the A-line auditory-evoked potential monitor is different from that measured by the Aspect A-2000 bispectral index monitor. The T(PEAK)s of propofol from auditory-evoked potential index and bispectral index, and the values of k(e0) calculated based on T(PEAK)s are different from previous reports and appear to be not affected by age. Further studies need to be taken to validate clinically the k(e0) values of propofol.

The efficacy of caudal morphine or bupivacaine combined with general anesthesia on postoperative pain and neuroendocrine stress response in children

The aim of this study was to compare the effectiveness of caudal morphine and bupivacaine usage on surgical stress response in children undergoing abdominal and genitourinary surgery while keeping anesthesia depth constant utilizing the bispectral index analysis (BIS). Following the approval of Institutional Review Board and informed parental consent, 28 children with ages ranging between 4 and 16 years with ASA physical status I and II , undergoing elective lower abdominal and genitourinary surgery were included in this study. Patients were randomized and separated into two subgroups. Before induction of anesthesia, patients were monitored for BIS. Epidural injection of 30 microg.kg(-1) morphine in 1 ml.kg(-1) saline for the first group (group M) and the same volume of (0.25%) bupivacaine for second group (group B) were administered via the sacral hiatus. We analyzed serum cortisol and glucose concentrations for evaluation of the stress response in the patients. Blood samples for cortisol and glucose were withdrawn at the beginning of induction (first samples), 40 min after surgical incision (second samples), and 40 min after end of the surgery (third samples). BIS scores of the patients were kept between 40 and 60 during the surgical procedure. Group B had significantly lower levels of cortisol than group M in the second samples. There was a significant increase in serum glucose level in group M compared with group B during the intraoperative and postoperative periods. We conclude that, caudal administration of bupivacaine is more effective than morphine for attenuating intraoperative and postoperative stress response to surgery in children.