Extremely low bispectral index value during robotic-assisted laparoscopic prostatectomy: A case report

Area of Science:

• Anesthesiology
• Neuroscience
• Surgical Technology

Background:

• The steep Trendelenburg position and pneumoperitoneum are common in robotic-assisted laparoscopic prostatectomy (RALP).
• These surgical conditions can potentially impact intracranial pressure, cerebral oxygenation, and cerebrovascular autoregulation.
• The bispectral index (BIS) is a measure of anesthetic depth and brain activity.

Observation:

• A case study involving a patient undergoing RALP experienced a significant decrease in BIS values 6 hours into the surgery.
• A concurrent decrease in the electroencephalography (EEG) suppression ratio (SR) was observed, suggesting reduced brain activity.
• The patient was managed under general anesthesia throughout the procedure.

Findings:

• The prolonged steep Trendelenburg position and pneumoperitoneum were associated with extremely low BIS values and decreased EEG suppression ratio.
• Upon release of the Trendelenburg position and termination of anesthesia, BIS values rapidly increased.
• The patient experienced no neurological deficits and was discharged following recovery.

Implications:

• Steep Trendelenburg positioning and pneumoperitoneum may induce electroencephalography (EEG) abnormalities, specifically manifesting as reduced BIS values.
• Anesthesiologists should be aware of the potential impact of these surgical maneuvers on brain activity monitoring.
• Further research may be warranted to understand the mechanisms and clinical significance of BIS changes in this context.