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Additional clinical observations utilizing bispectral analysis.

N A Sandler1

  • 1Department of Oral and Maxillofacial Surgery, University of Minnesota, Minneapolis, Minnesota, USA. sandl003@tc.umn.edu

Anesthesia Progress
|July 4, 2001
PubMed
Summary
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The bispectral (BIS) index shows higher values with ketamine and midazolam compared to other sedatives. Bispectral analysis aids in monitoring general anesthesia depth in nonintubated patients.

Area of Science:

  • Anesthesiology
  • Neuroscience
  • Medical Devices

Background:

  • The bispectral (BIS) index is a tool used to monitor anesthetic depth.
  • Ketamine and midazolam are commonly used anesthetic agents.
  • General anesthesia in nonintubated patients presents unique monitoring challenges.

Purpose of the Study:

  • To evaluate the bispectral (BIS) index in nonintubated patients undergoing procedures with ketamine and midazolam.
  • To assess the utility of bispectral analysis in maintaining general anesthesia without local anesthesia.
  • To compare BIS index values across different anesthetic agents.

Main Methods:

  • Bispectral analysis was performed on 25 subjects undergoing extraction procedures with ketamine and midazolam.
  • BIS index values were recorded during general anesthesia with propofol.

Related Experiment Videos

  • Observations were made on BIS index behavior when local anesthesia was omitted.

    • Main Results:

    • BIS index values remained high (in the 80s, low of 77) with ketamine and midazolam, unlike typical sedative ranges (50-70).
    • BIS index readings in the 30s were common with propofol, with a lowest observed value of 18.
    • Bispectral analysis effectively trended anesthetic states and guided propofol dosage adjustments.
    • No laryngospasm or total airway obstruction occurred; one instance of partial obstruction was resolved by repositioning.

    Conclusions:

    • Bispectral analysis is valuable for monitoring anesthetic depth in nonintubated patients, particularly during general anesthesia without local anesthetic infiltration.
    • BIS index values are consistently higher with ketamine compared to other hypnotics.
    • A limitation exists in titrating midazolam-induced sedation when ketamine is co-administered, as BIS levels may not decrease as expected.