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Published on: July 20, 2022
[Bispectral index monitoring in fast track pediatric cardiac surgery]
Miyuki Maruyama1, Hirotsugu Okamoto, Junko Suwa
1Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara 288-8555.
Insights
The bispectral index (BIS) effectively monitored sedation levels in children during fast track cardiac surgery. Caution is advised during rewarming due to potential temporary increases in BIS, indicating lighter anesthesia.
Area of Science:
- Anesthesiology
- Pediatric Cardiac Surgery
- Neurophysiology
Background:
- Assessing depth of anesthesia in pediatric cardiac surgery is critical.
- The bispectral index (BIS) is a potential tool for monitoring consciousness levels.
- Fast track cardiac surgery protocols aim for rapid recovery and extubation.
Purpose of the Study:
- To evaluate the bispectral index (BIS) as an indicator of consciousness.
- To assess BIS changes during fast track cardiac surgery in infants and children.
- To correlate BIS values with anesthetic depth and patient outcomes.
Main Methods:
- Twenty-one pediatric patients undergoing fast track cardiac surgery were enrolled.
- Anesthesia was maintained using sevoflurane and fentanyl.
- Bispectral index (BIS) was continuously monitored throughout the surgical procedure, including cardiopulmonary bypass and mild hypothermia.
Main Results:
- Bispectral index (BIS) generally remained below 70 with sevoflurane concentrations of 0.5-3.0%.
- A temporary increase in BIS above 70 was observed in approximately 50% of children during rewarming from mild hypothermia.
- Increased sevoflurane dosage was used to manage these BIS elevations, ensuring adequate sedation.
Conclusions:
- The bispectral index (BIS) appears to be a reliable indicator of adequate sedation during fast track cardiac surgery in children.
- Increased BIS values during the rewarming phase may signify lighter anesthesia, necessitating careful titration of anesthetic agents.
- The study supports the use of BIS monitoring for optimizing anesthetic management and facilitating early extubation in pediatric cardiac surgery.
Background:
We evaluated the changes in the bispectral index (BIS) as a potential indicator of level of consciousness in infants and children undergoing fast track cardiac surgery.
Methods:
Twenty-one children undergoing fast track cardiac surgery were recruited into this study. Anesthesia was maintained with inhaled sevoflurane and intravenous fentanyl 10 microg x kg(-1). Cardiopulmonary bypass (CPB) with mild hypothermia and an immediate tracheal extubation protocol were used. BIS was recorded throughout the operation.
Results:
In average, BIS was kept almost under 70 with 0.5-3.0% of sevoflurane. During rewarming from mild hypothermia, BIS increased temporarily over 70 in about a half of children. We, therefore, treated them by increasing sevoflurane concentration. Nineteen children were extubated in the operating room, and two patients were extubated in ICU within three hours after surgery.
Conclusions:
BIS was kept within the level of adequate sedation during surgery. However, since the increase in BIS during the rewarming phase could reflect light anesthesia, caution should be taken around this phase.
