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

2004 ◽  
Vol 21 (4) ◽  
pp. 330-331 ◽  
Author(s):  
B. Bein ◽  
P. H. Tonner
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Bispectral Index ◽  
Temperature Changes ◽  
Influence Of Temperature ◽  
Bispectral Index Monitoring

scholarly journals Impact of Bispectral Index Monitoring on Propofol Administration in Patients Undergoing Cardiopulmonary Bypass

2007 ◽  
Vol 35 (3) ◽  
pp. 342-347 ◽  
Author(s):  
C. L. Chiu ◽  
G. Ong ◽  
A. A. Majid
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Bispectral Index ◽  
Standard Dose ◽  
Controlled Trial ◽  
Target Concentration ◽  
Hypothermic Cardiopulmonary Bypass ◽  
Bispectral Index Monitoring ◽  
Group B ◽  
Index Value

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.

scholarly journals Perioperative Cerebral Ischaemia in Cardiac Surgery and BIS

2005 ◽  
Vol 33 (4) ◽  
pp. 514-517 ◽  
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.

Propofol requirement titrated to bispectral index: a comparison between hypothermic and normothermic cardiopulmonary bypass

Perfusion ◽  
2009 ◽  
Vol 24 (1) ◽  
pp. 27-32 ◽  
Author(s):  
PJ Mathew ◽  
GD Puri ◽  
RS Dhaliwal
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Bispectral Index ◽  
Adult Patients ◽  
Study Group ◽  
Factors Affecting ◽  
Inter Quartile Range ◽  
Elective Cardiac Surgery ◽  
Quartile Range ◽  
Hypothermic Group

Though propofol requirement is expected to decrease during cardiopulmonary bypass (CPB), a few studies have failed to demonstrate this. The factors affecting pharmacokinetics of propofol and, therefore, the requirement, are different during hypothermic and normothermic CPB. We evaluated and compared the requirement of propofol during hypothermic and normothermic CPB. Fifty adult patients scheduled for elective cardiac surgery on CPB were recruited and randomly allocated into hypothermic CPB (28–300 C) (Group H) and normothermic CPB (35–370 C) (Group N) groups. Patients were induced and maintained with propofol titrated to maintain a target bispectral index (BIS) of 50 ± 10. Propofol requirement (mean ± SD) was similar in normothermic and hypothermic groups, both before CPB (4.9 ± 1.5 mg.kg−1hr−1 in Group N, 4.6 ± 1.5 mg.kg−1hr−1 in Group H) and after cessation of bypass (p > 0.05) (4.6 ± 1.8 mg.kg−1hr−1 in Group N and 4.3 ± 1.7 mg.kg−1hr−1 in Group H). CPB significantly reduced (p < 0.001) propofol requirements in both arms of the study (Group N: 2.9 ± 1.4 mg.kg−1hr−1and Group H: 1.3 ± 0.7 mg.kg−1hr−1). This reduction was more pronounced in the hypothermic group (p < 0.001). The BIS (median ± inter quartile range) remained constant during normothermic CPB (50 ± 8.8), but declined significantly during hypothermic CPB (41 ± 5.6) despite decreased usage of propofol during hypothermia. No patient had recall of intra-operative events. CPB decreases the magnitude of propofol requirements and the effect of hypothermic CPB is significantly more than that of normothermic CPB.

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