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Bispectral index under propofol anesthesia in children: a comparative randomized study between TIVA and TCI
Nicolas Louvet1, Agnès Rigouzzo1, Nada Sabourdin1
1Département d'Anesthésie-Réanimation, Hôpital Armand Trousseau, Paris, France.
Insights
Bispectral Index (BIS)-guided propofol infusion in children provides better control than clinical signs alone. Target-controlled infusion (TCI) and manual BIS-guided TIVA showed similar efficacy for anesthesia depth.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pharmacodynamics
Background:
- Limited studies compare propofol infusion modes in pediatric TIVA.
- Propofol and remifentanil are common agents for TIVA in children.
Purpose of the Study:
- Compare Bispectral Index (BIS) profiles across four propofol infusion methods.
- Evaluate manual titration vs. BIS-guided TIVA and TCI models (Kataria, Schnider).
Main Methods:
- 66 children (4-14 years) randomized into four groups.
- Groups: TIVA0 (clinical signs), TIVABIS (manual BIS), TCI KBIS, TCI SBIS.
- Measured time in target BIS range (45-55), bias, and imprecision.
Main Results:
- TIVA0 had significantly less time in the target BIS range (31%) compared to BIS-guided groups (53-59%).
- TIVA0 showed greater imprecision in maintaining anesthesia depth.
- Schnider model TCI had faster BIS response and recovery times than Kataria model.
Conclusions:
- Manual propofol titration based on clinical signs increases over/underdosage risk in children.
- BIS-guided propofol infusion (TIVA or TCI) ensures safer anesthesia depth.
- Pharmacodynamic monitoring is crucial for pediatric propofol anesthesia.
Background:
In children, only a few studies have compared different modes of propofol infusion during a total intravenous anesthesia (TIVA) with propofol and remifentanil. The aim of this study was to compare Bispectral Index (BIS) profiles (percentage of time spent at adequate BIS values) between four modes of propofol infusion: titration of the infusion rate on clinical signs (TIVA0 ), titration of the infusion rate on the BIS (TIVABIS ), target controlled infusion (TCI) guided by the BIS either with the Kataria model (TCI KBIS ) or the Schnider model (TCI SBIS ).
Methods:
Sixty-six children (aged from 4 to 14 years) were prospectively randomized into one of the four groups. In the TIVA0 group, the anesthesiologist was blinded to the BIS. In each group, the percentage of time with adequate BIS values (45-55), the bias, and imprecision were calculated.
Results:
The propofol consumption was similar in the four groups. During the maintenance phase, the percentage of time spent in the targeted BIS range was significantly lower in the TIVA0 group compared to the three other groups (TIVA0 : 31% ± 22, TIVABIS : 59% ± 17, TCI KBIS : 53% ± 12, TCI SBIS : 56% ± 17). The bias was not statistically different between the four groups, but the imprecision was larger for the TIVA0 group. Compared to the Kataria model, the Schnider model was associated with shorter time delay to reach the desired BIS, to eyes opening, and to tracheal extubation.
Conclusions:
Propofol administration using manual infusion guided by clinical signs was associated with higher risks of over- or underdosage when compared to BIS-guided administrations. When propofol infusion was guided by the BIS, no major difference was found between TIVA and TCI (either with the Kataria or the Schnider model). This study highlights the need of a pharmacodynamic feedback during propofol anesthesia in children.
