No Evidence of Memory Processing During Propofol-Remifentanil Target-Controlled Infusion Anesthesia With Bispectral Index Monitoring in Cardiac Surgery

Propofol anaesthesia using target control infusion during cardiac surgery has become more popular recently. However, without depth of anaesthesia monitoring, the standard target concentration used may be higher than necessary to maintain adequate hypnosis during hypothermic cardiopulmonary bypass. The purpose of this study was to evaluate the effect of bispectral index monitoring on propofol administration during hypothermic cardiopulmonary bypass. After ethics committee approval and written informed consent, 20 New York Heart Association class I-III patients scheduled for elective cardiac surgery requiring hypothermic cardiopulmonary bypass were studied in this prospective randomised controlled trial. In group C, routine anaesthesia was practised, where patients received propofol at target concentration between 1.5 to 2.5 μ/ml during cardiopulmonary bypass. In group B, the target concentration was titrated to a bispectral index value of 40 to 50. Mean arterial pressure and bispectral index were recorded at various time intervals. The use of propofol, phenylephrine, sodium nitroprusside and adrenaline were recorded. The median propofol administration in group B was significantly less than that in group C (2.9 mg/kg/h compared to 6.0 mg/kg/h). The bispectral index value during bypass was significantly lower in group C than in group B, reflecting a deeper state of anaesthesia. There was no difference in the use of inotropes, vasoconstrictors or vasodilators. Bispectral index monitoring enables a 50% reduction in propofol administration at this standard dose during hypothermic cardiopulmonary bypass.

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Bispectral index monitoring in patients undergoing cardiac surgery under cardiopulmonary bypass: the influence of temperature changes should be considered

European Journal of Anaesthesiology ◽

10.1097/00003643-200404000-00020 ◽

2004 ◽

Vol 21 (4) ◽

pp. 330-331 ◽

Cited By ~ 1

Author(s):

B. Bein ◽

P. H. Tonner

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Bispectral Index ◽

Temperature Changes ◽

Influence Of Temperature ◽

Bispectral Index Monitoring

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Perioperative Cerebral Ischaemia in Cardiac Surgery and BIS

Anaesthesia and Intensive Care ◽

10.1177/0310057x0503300415 ◽

2005 ◽

Vol 33 (4) ◽

pp. 514-517 ◽

Cited By ~ 18

Author(s):

J. Villacorta ◽

F. Kerbaul ◽

F. Collart ◽

C. Guidon ◽

M. Bonnet ◽

...

Keyword(s):

Cardiac Surgery ◽

Mitral Valve ◽

Ct Scan ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Bispectral Index ◽

Cerebral Ischaemia ◽

Air Embolism ◽

Aortic Cross Clamp ◽

Bispectral Index Monitoring

A 46-year-old woman was monitored by bispectral index monitoring (BIS) during redo aortic and mitral valve replacement. On release of the aortic cross clamp there was a sudden, severe, unexplained, and sustained fall in the BIS value. Postoperatively, a CT scan was consistent with multiple ischaemic lesions. The lesions were presumed to be due to air embolism. This case suggests that a sudden unexplained and persistent fall in BIS may indicate cerebral ischaemia.

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