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Use of the Bispectral Index to Predict Eye Position of Children during General Anesthesia
Koung Hoon Kook1, Seung Ah Chung2, Suyoun Park1
1Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea.
Insights
Bispectral index (BIS) monitoring during anesthesia may help predict eye position. Higher BIS values correlated with increased eye elevation, suggesting anesthesia depth should be maintained below 65 for ophthalmic surgery.
Area of Science:
- Anesthesiology
- Ophthalmology
- Neurophysiology
Background:
- Anesthesia depth monitoring is crucial for patient safety.
- The bispectral index (BIS) is a common electroencephalography-derived measure of anesthetic effect.
- Eye position can be an indicator of anesthetic depth, particularly during ophthalmic procedures.
Purpose of the Study:
- To evaluate the correlation between bispectral index (BIS) values and eye position during general anesthesia.
- To determine if BIS monitoring can predict ocular elevation during surgical procedures.
- To establish a threshold BIS value for maintaining adequate anesthesia depth and preventing eye movement.
Main Methods:
- Investigated 32 children undergoing epiblepharon surgery under general anesthesia.
- Continuously recorded BIS values from induction to awakening.
- Video-recorded and analyzed eye positions, scoring vertical eye elevation relative to the medial canthus.
Main Results:
- BIS values showed an inverse correlation with anesthetic concentration and a positive correlation with eye elevation score (p = 0.011).
- Patients with BIS values > 65 exhibited significantly greater mean eye position scores.
- 34.4% of patients had significant ocular elevation, with a mean BIS of 61.6.
Conclusions:
- High BIS values indicate lighter anesthesia and are associated with increased eye elevation.
- BIS monitoring may serve as a useful tool for predicting eye position during anesthesia.
- Maintaining BIS values below 65 is recommended to ensure adequate anesthesia depth and minimize ocular movement during ophthalmic surgery.
Purpose:
To assess the relationship between eye position and anesthesia depth using the bispectral index (BIS) value, a parameter derived from electroencephalography data.
Methods:
We investigated the relationship between BIS value and eye position in 32 children who underwent surgery for epiblepharon under general anesthesia. BIS values were recorded continuously throughout the procedure (from induction to awakening). Eye positions were video-recorded and analyzed after surgery. The vertical position of each eye was scored according to its height in relation to the medial canthus. An eye position in which the upper eyelid covered one-third of the cornea was defined as a significant ocular elevation.
Results:
The BIS value correlated inversely with the end-tidal concentration of each anesthetic agent, whereas it correlated positively with the eye elevation score (eye position = 0.014 × BIS + 0.699, p = 0.011). The mean eye position score was significantly greater in patients whose BIS values were over 65. Eleven patients (34.4%) had significant ocular elevation; their mean concurrent BIS value was 61.6. Two of these patients had elevation during surgery and 9 had elevation during emergence from anesthesia.
Conclusions:
We found that high BIS values were correlated with low levels of anesthetic concentration and high eye position, suggesting that BIS monitoring may be useful for predicting eye position during anesthesia. Particular attention must be given to eye position during ophthalmic surgery. Anesthesia depth can be maintained by assuring that the BIS value remains below 65.
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