Bispectral index monitored balanced anesthesia technique for pheochromocytoma resection

ABSTRACT Malignant hyperthermia is an acute hypermetabolic crisis triggered in susceptible patients by the administration of succinylcholine or a volatile anesthetic agent. When anesthesia care is provided to malignant hyperthermia-susceptible patients, a total intravenous anesthesia technique with propofol is frequently chosen. However, coexisting allergies to egg and soybeans may contraindicate the use of propofol. We present our experience with the use of dexmedetomidine as part of the anesthesia regimen in 3 patients with family histories of malignant hyperthermia and personal histories of egg or soybean allergies. In 2 patients, dexmedetomidine was used as part of a general anesthesia regimen and for sedation during spinal anesthesia in the third patient. Previous reports of the use of dexmedetomidine in patients susceptible to malignant hyperthermia are reviewed, and its benefits in such patients are discussed.

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Comparison of bispectral index-guided and fixed-gas concentration techniques in desflurane and remifentanil anesthesia: A randomized controlled trial

PLoS ONE ◽

10.1371/journal.pone.0241828 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241828

Author(s):

Seong Mi Yang ◽

Yoo Sun Jung ◽

Chul-Woo Jung ◽

Won Ho Kim ◽

Soo Bin Yoon ◽

...

Keyword(s):

Bispectral Index ◽

Minimum Alveolar Concentration ◽

Controlled Trial ◽

Systolic Arterial Pressure ◽

Hemodynamic Instability ◽

Gas Concentration ◽

Randomized Controlled ◽

Balanced Anesthesia ◽

Desflurane Concentration ◽

Secondary Endpoints

Anesthesia with desflurane and remifentanil can be maintained with either fixed or titrated desflurane concentration. We hypothesized that the fixed-gas concentration (FG) method would reduce the number of anesthetic titrations without hypnotic and hemodynamic instability compared to the bispectral index (BIS)-guided (BG) method. Forty-eight patients were randomly allocated to the FG or BG groups. In the FG group, desflurane vaporizer setting was fixed at 1 age-corrected minimum alveolar concentration (MAC). In the BG group, desflurane was titrated to target a BIS level at 50. Remifentanil was titrated to maintain a systolic arterial pressure (SAP) of 120 mmHg in both groups. Our primary endpoint was the hypnotic stability measured by the wobble of BIS in performance analysis, and the secondary endpoints included the wobble of SAP, mean BIS value during surgery, and the number of anesthetic titrations. The BIS in the FG group showed significantly less wobble (3.9 ± 1.1% vs 5.5 ± 1.5%, P <0.001) but lower value (33 ± 6 vs 46 ± 7, P <0.001) than BG group. The wobble of SAP showed no difference between groups [median (inter-quartile range), 5.0 (4.1–7.5)% vs 5.2 (4.2–8.3)%, P = 0.557]. The numbers of anesthetic titrations in the FG group were significantly lower than the BG group (0 ± 0 vs 8 ± 5, P<0.001 for desflurane, 13 ± 13 vs 22 ± 17, P = 0.047 for remifentanil). Less wobble in BIS and reduced anesthetic titration without hemodynamic instability during the FG technique may be practical in balanced anesthesia using desflurane and remifentanil anesthesia. Clinical trial: This study was registered at ClinicalTrials.gov (NCT02283866).

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Bispectral Index Monitoring Allows Faster Emergence and Improved Recovery from Propofol, Alfentanil, and Nitrous Oxide Anesthesia

Anesthesiology ◽

10.1097/00000542-199710000-00014 ◽

1997 ◽

Vol 87 (4) ◽

pp. 808-815 ◽

Cited By ~ 429

Author(s):

Tong J. Gan ◽

Peter S. Glass ◽

Alastair Windsor ◽

Fredrick Payne ◽

Carl Rosow ◽

...

Keyword(s):

Nitrous Oxide ◽

Patient Outcomes ◽

Bispectral Index ◽

Clinical Signs ◽

Postanesthesia Care Unit ◽

Anesthetic Practice ◽

Standard Clinical Practice ◽

Significant Difference ◽

Balanced Anesthesia ◽

Oxide Anesthesia

Background The bispectral index (BIS), a parameter derived from the electroencephalograph (EEG), has been shown to correlate with increasing sedation and loss of consciousness. This study determined whether addition of BIS monitoring to standard anesthetic practice results in improvements in the conduct of anesthesia or in patient outcomes. Methods Three hundred two patients receiving a propofol-alfentanil-nitrous oxide anesthetic were studied at four institutions. Thirty-four patients were initially enrolled to determine preexisting anesthetic practice and patient outcomes at each institution. Subsequent patients were randomized to either standard clinical practice (SP group), or standard practice plus BIS monitoring (BIS group). In all patients, the anesthesiologist attempted to provide a stable anesthetic with the fastest possible recovery. BIS was recorded for all patients, but viewed only in the BIS group. In the BIS group, propofol infusions were adjusted to achieve a target BIS between 45-60, increasing to 60-75 during the final 15 min of the case. In the SP group, propofol dose adjustments were made based only on standard clinical signs. Drug use, intraoperative responses, and patient recovery parameters were recorded. Results Demographics were similar between groups. Compared with the SP group, patients in the BIS group required lower normalized propofol infusion rates (134 vs. 116 microg x kg[-1] x min[-1]; P < 0.001), were extubated sooner (11.22 vs. 7.25 min; P < 0.003), had a higher percentage of patients oriented on arrival to PACU (43% vs. 23%; P < 0.02), had better postanesthesia care unit (PACU) nursing assessments (P < 0.001), and became eligible for discharge sooner (37.77 vs. 31.70 min; P <0.04). There was no significant difference in the incidence of intraoperative responses between the groups. Conclusions Titrating propofol with BIS monitoring during balanced anesthesia decreased propofol use and significantly improved recovery. Intraoperative course was not changed. These findings indicate that the use of BIS may be valuable in guiding the administration of propofol intraoperatively.

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Bispectral Index-Monitored Anesthesia Technique for Transsternal Thymectomy

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492309338120 ◽

2009 ◽

Vol 17 (4) ◽

pp. 389-394 ◽

Cited By ~ 1

Author(s):

Madan Mohan Maddali ◽

Prakash Veru Matreja ◽

Mamie Zachariah

Keyword(s):

Bispectral Index ◽

Subcutaneous Tissue ◽

Tracheal Extubation ◽

Neuromuscular Blocking ◽

Neuromuscular Blocking Agents ◽

Skin Closure ◽

Blocking Agents ◽

Bispectral Index Monitoring ◽

Oral Midazolam ◽

Balanced Anesthesia

To evaluate the role of bispectral index monitoring as an adjunct to balanced anesthesia in patients with myasthenia gravis undergoing transsternal thymectomy without the use of neuromuscular blocking agents, 10 patients were enrolled into this prospective observational study. After oral midazolam premedication, general anesthesia was induced with fentanyl, propofol, and sevoflurane. Tracheal intubation was performed without neuromuscular blocking agents. During maintenance, continuous monitoring of physiological and bispectral index parameters was used to titrate the doses of remifentanil, propofol, and sevoflurane. Sevoflurane concentration and propofol doses were adjusted to achieve bispectral index values in the high 30s to low 40 s. Propofol was discontinued when the sternum was approximated. Remifentanil infusion was stopped on subcutaneous tissue closure, and sevoflurane was switched off when nearing completion of skin closure. Tracheal extubation was performed when extubation criteria were met. On extubation, bispectral index levels were above 90. The median time from extubation to discontinuation of propofol was 28 ± 4 min, that of remifentanil was 21 ± 4 min, and it was 9 ± 5 min for sevoflurane. Bispectral index monitoring provided excellent hemodynamic control during surgery, and allowed early problem-free tracheal extubation.

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