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Published on: January 13, 2018
Changes of bispectral index during recovery from general anesthesia with 2% propofol and remifentanil in children
Hye-Jin Park1, Yong Lak Kim, Chong Sung Kim
1Department of Anesthesiology, College of Medicine, Eulji University, Korea.
Insights
In preschool children, the bispectral (BIS) index moderately correlated with predicted propofol plasma concentrations during anesthesia emergence. This finding aids in monitoring anesthetic depth in pediatric patients.
Area of Science:
- Anesthesiology
- Neuroscience
- Pharmacology
Background:
- The bispectral (BIS) index is a key pharmacodynamic tool for assessing anesthesia's central nervous system effects.
- Understanding BIS index behavior during emergence is crucial for pediatric anesthesia management.
Purpose of the Study:
- To investigate the relationship between the BIS index and predicted propofol plasma concentration during emergence in children.
- To evaluate BIS index as a predictor of anesthetic depth in pediatric patients undergoing target-controlled infusion (TCI) of propofol.
Main Methods:
- A study involving 30 pediatric patients (2-7 years) undergoing anesthesia with TCI propofol and remifentanil.
- BIS values were recorded as propofol infusion was reduced, noting spontaneous respiration and command following.
- Propofol plasma concentrations were predicted using TCI models.
Main Results:
- A moderate negative correlation (r = -0.559, P < 0.001) was observed between BIS index and predicted propofol plasma concentration.
- At the return of spontaneous respiration, mean BIS was 77.2 ± 5.3 with a propofol concentration of 1.6 ± 0.3 µg/mL.
- When patients could obey commands, mean BIS was 82.4 ± 5.6 with a propofol concentration of 1.5 ± 0.3 µg/mL.
Conclusions:
- The BIS index shows a moderate correlation with predicted propofol plasma concentration in preschool children during emergence.
- BIS index can serve as a useful, albeit moderate, indicator of anesthetic effect in this age group.
Background:
The bispectral (BIS) index is a pharmacodynamic measure of the effect of anesthesia on the central nervous system. The aim of this study was to investigate the relationship between BIS index and predicted plasma concentration of propofol delivered by target controlled infusion (TCI) during emergence in children.
Methods:
With approval of IRB, 30 patients (2-7 years) were included in this study. Anesthesia was with TCI propofol 3-5 microg.ml(-1) and remifentanil 7.5 ng.ml(-1) to maintain BIS 40-60 and the propofol concentration was fixed at 3 microg.ml(-1) Remifentanil infusion was stopped 10 min before the end of surgery. BIS values were recorded after reducing propofol in decrement of 0.2 microg.ml(-1). BIS values were checked when spontaneous respiration occurred and children were able to obey a command (eye opening or hand grasping).
Results:
Spearman's correlation analysis showed negative correlation between BIS and propofol plasma concentration (r = -0.559, P < 0.001). When respiration returned, mean BIS was 77.2 +/- 5.3 and propofol plasma concentration 1.6 +/- 0.3 microg.ml(-1) and when a verbal command was obeyed, BIS was 82.4 +/- 5.6 and propofol plasma concentration 1.5 +/- 0.3 microg.ml(-1).
Conclusions:
In preschool children, BIS moderately correlated with the predicted plasma concentration of propofol.
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