Öz
Aim. We aimed to investigate the effect of monitoring the depth of anesthesia with bispectral Index (BIS) on consumption of total intravenous anesthetic agent, recovery criteria and to be aware. Methods. ASA physical status I-II, between 20-60 age, 60 patients planned to undergoing cholecystectomy under general anesthesia were enrolled to study. Patients were randomly divided into 2 groups. Patients monitored by bispectral index monitoring (BIS) were classified as Group BIS and patients monitored by hemodynamic parameters were classified as group control. Induction of anesthesia in both groups was performed with 1 mg/kg/min remifentanil. In Group Control, propofol was adjusted to 2 mg/kg, in group BIS, propofol was adjusted to BIS 40-60. All patients were curarized with rocuronyum 0.6 mg kg. Maintenance of anesthesia was caried out with propofol and remifentanil. Total propofol consumption and time to extubation and to be aware were also recorded. Results. Demographic data were similar between groups. In BIS group, propofol consumption (p<0.05) were significantly lower. Time to extubation was shorter in the BIS group (p<0.05) differences were not found between the groups in terms of being aware. Both groups were similar in terms of heart rate, mean arterial pressure, and length of hospital stay. Conclusion. In patients undergoing laparoscopic cholecystectomy, it is enough to make anesthesia titration by hemodynamic parameters. However, we concluded that monitoring by the BIS may help to prevent the use of more anesthetic agents and provide faster recovery.
Anahtar Kelimeler
Kaynakça
- Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: The B-Aware randomised controlled trial. Lancet 2004; 363: 1757-63.
- Technology Overview: Bispectral Index. Aspect Medical Systems, Inc., http://www.aspectmedical.com. (Erişim tarihi 26.08.2013)
- Stanski DR, Shafer SL. Measuring Depth of Anesthesia, Miller’s Anesthesia; Ronald D. Miller, Sixth edition, volume 1, chapter 31;1249-57.
- Kochs E, Bischoff P, Pichlmeier U, Schulte am Esch J. Surgical stimulation induces changes in brain electrical activity during isoflurane/nitrous oxide anesthesia. A topographic electroencephalographic analysis. Anesthesiology 1994; 80: 1026-34.
- Guignard B, Coste C, Menigaux C, Chauvin M. Reduced isoflurane consumption with bispectral index monitoring. Acta Anaesthesiol Scand 2001; 45: 308-14.
- Kakinohana M, Miyata Y, Kawabata T, Kawashima S, Tokumine J, Sugahara K. Bispectral index decreased to "0" in propofol anesthesia after a cross-clamping of descending thoracic aorta. Anesthesiology 2003; 99: 1223-5.
- Hughes SC, Kan RE, Rosen MA, et al. Remifentanil: ultra-short acting opioid for obstetric anesthesia (abstract). Anesthesiology 1996; 85: A 894.
- Jhaveri R, Joshi P, Batenhorst R, Baughman V, Glass PS. Dose comparison of remifentanil and alfentanil for loss of consciousness. Anesthesiology 1997; 87: 253Moerman N, Bonke B, Oosting J. Awareness and recall during general anesthesia. Facts and feelings. Anesthesiology 1993; 79: 454-64.
- Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. Lancet 2000; 355: 707-11.
- Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, Domino KB. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg 2004; 99: 833-9.
- Xu L, Wu AS, Yue Y. The incidence of intra-operative awareness during general anesthesia in China: a multi-center observational study. Acta Anesth Scand 2009; 53: 873-82.
- Johansen JW, Sebel PS. Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology 2000; 93: 1336
- Struys M, Versichelen L, Byttebier G, Mortier E, Moerman A, Rolly G. Clinical usefulness of the bispectral index for titrating propofol target effect-site concentration. Anaesthesia 1998; 53: 4-12.
- White PF, Tang J, Romero GF, Wender RH, Naruse R, Sloninsky A, Kariger R. A comparison of state and response entropy versus bispectral index values during the perioperative period. Anesth Analg 2006; 102: 160-7.
- Burrow B, McKenzie B, Case C. Do anaesthetized patients recover better after bispectral index monitoring? Anaesth Intensive Care 2001; 29: 239-45.
- Jensen EW, Litvan H, Revuelta M, Rodriguez BE, Caminal P, Martinez P, Vereecke H, Struys MM. Cerebral state index during propofol anesthesia: a comparison with the bispectral index and the A-line ARX index. Anesthesiology 2006; 105: 28-36.
- Bauer M, Wilhelm W, Kraemer T, Kreuer S, Brandt A, Adams HA, Hoff G, Larsen R. Impact of bispectral index monitoring on stress response and propofol consumption in patients undergoing coronary artery bypass surgery. Anesthesiology 2004; 101: 1096-104.
- Gan TJ, Glass PS, Windsor A, Payne F, Rosow C, Sebel P, Manberg P. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology 1997; 87: 808-15.
- Ibraheim O, Alshaer A, Mazen K, El-Dawlaty A, Turkistani A, Alkathery K, AlZahrani T, Al-Dohayan A, Bukhari A. Effect of bispectral index (BIS) monitoring on postoperative recovery and sevoflurane consumption among morbidly obese patients undergoing laparoscopic gastric banding. Middle East J Anesthesiol 2008; 19: 819-30.
- Johansen JW, Sebel PS, Sigl JC. Clinical impact of hypnotic-titration guidelines based on EEG bispectral index (BIS) monitoring during routine anesthetic care. J Clinical Anesth 2000; 12: 433-43.
Bispektral İndeks (BIS) ile total intravenöz anestezi derinliği izlemi; propofol ajan tüketimi, derlenme kriterleri ve farkında olmaya etkisi
Öz
Özet
Amaç. Bispektral İndeks (BIS) ile anestezi derinliği izlemenin, kullanılan total intravenöz anestezik madde tüketimi ve derlenme kriterleri ve farkında olmaya etkisini araştırmak araştırmak üzere planlandı. Yöntem. Genel anestezi ile kolesistektomi planlanan, 20-60 yaş arası, ASA I-III, 60 hasta çalışmaya alındı. Olgular rasgele 2 gruba ayrıldı. Bispektral indeks monitörizasyonu ile izlenen grup; Grup BIS, hemodinamik parametrelerle izlenen grup; Grup Kontrol olarak sınıflandırıldı. Her iki grupta da anestezi indüksiyonunda 1 μg kg-1 remifentanil uygulandı. Kontrol grubunda propofol 2 mg kg-1, BIS grubunda BIS 40-60 arasında olacak şekilde ayarlandı. 0,6 mg kg-1 rocuronyum ile hastalar kürarize edildi. Anestezi idamesi propofol ve remifentanil ile yapıldı. Toplam propofol tüketimi, ekstübasyon zamanı ve farkında olma kaydedildi. Bulgular. Demografik veriler gruplar arasında benzerdi. BIS grubunda propofol tüketimi (p<0,05), anlamlı olarak düşük bulundu. Ekstübasyon zamanı BIS grubunda daha kısa bulundu (p<0,05), farkında olma açısından gruplar arasında fark bulunmadı. Her iki grup, kalp atım hızları, ortalama arteriyel basınçları ve hastanede kalış süreleri bakımından benzerdi. Sonuç. ASA I-III laparoskopik kolesistektomi uygulanan hastalarda anestezi titrasyonunu hemodinamik parametrelere göre yapmanın yeterli olduğu ancak BIS ile monitörize takip etmenin fazla anestezik ajan kullanımını önlemeye ve anesteziden daha hızlı derlenmeye yardımcı olduğu kanısına varıldı.
Anahtar sözcükler: Total intravenöz anestezi, EEG, bispektral indeks
Abstract
Aim. We aimed to investigate the effect of monitoring the depth of anesthesia with bispectral Index (BIS) on consumption of total intravenous anesthetic agent, recovery criteria and to be aware. Methods. ASA physical status I-II, between 20-60 age, 60 patients planned to undergoing cholecystectomy under general anesthesia were enrolled to study. Patients were randomly divided into 2 groups. Patients monitored by bispectral index monitoring (BIS) were classified as Group BIS and patients monitored by hemodynamic parameters were classified as group control. Induction of anesthesia in both groups was performed with 1 mg/kg/min remifentanil. In Group Control, propofol was adjusted to 2 mg/kg, in group BIS, propofol was adjusted to BIS 40-60. All patients were curarized with rocuronyum 0.6 mg kg-1. Maintenance of anesthesia was caried out with propofol and remifentanil. Total propofol consumption and time to extubation and to be aware were also recorded. Results. Demographic data were similar between groups. In BIS group, propofol consumption (p<0.05) were significantly lower. Time to extubation was shorter in the BIS group (p<0.05) differences were not found between the groups in terms of being aware. Both groups were similar in terms of heart rate, mean arterial pressure, and length of hospital stay. Conclusion. In patients undergoing laparoscopic cholecystectomy, it is enough to make anesthesia titration by hemodynamic parameters. However, we concluded that monitoring by the BIS may help to prevent the use of more anesthetic agents and provide faster recovery.
Keywords: Total intravenous anesthesia, EEG, bispectral indexAnahtar Kelimeler
Kaynakça
- Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: The B-Aware randomised controlled trial. Lancet 2004; 363: 1757-63.
- Technology Overview: Bispectral Index. Aspect Medical Systems, Inc., http://www.aspectmedical.com. (Erişim tarihi 26.08.2013)
- Stanski DR, Shafer SL. Measuring Depth of Anesthesia, Miller’s Anesthesia; Ronald D. Miller, Sixth edition, volume 1, chapter 31;1249-57.
- Kochs E, Bischoff P, Pichlmeier U, Schulte am Esch J. Surgical stimulation induces changes in brain electrical activity during isoflurane/nitrous oxide anesthesia. A topographic electroencephalographic analysis. Anesthesiology 1994; 80: 1026-34.
- Guignard B, Coste C, Menigaux C, Chauvin M. Reduced isoflurane consumption with bispectral index monitoring. Acta Anaesthesiol Scand 2001; 45: 308-14.
- Kakinohana M, Miyata Y, Kawabata T, Kawashima S, Tokumine J, Sugahara K. Bispectral index decreased to "0" in propofol anesthesia after a cross-clamping of descending thoracic aorta. Anesthesiology 2003; 99: 1223-5.
- Hughes SC, Kan RE, Rosen MA, et al. Remifentanil: ultra-short acting opioid for obstetric anesthesia (abstract). Anesthesiology 1996; 85: A 894.
- Jhaveri R, Joshi P, Batenhorst R, Baughman V, Glass PS. Dose comparison of remifentanil and alfentanil for loss of consciousness. Anesthesiology 1997; 87: 253Moerman N, Bonke B, Oosting J. Awareness and recall during general anesthesia. Facts and feelings. Anesthesiology 1993; 79: 454-64.
- Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. Lancet 2000; 355: 707-11.
- Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, Domino KB. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg 2004; 99: 833-9.
- Xu L, Wu AS, Yue Y. The incidence of intra-operative awareness during general anesthesia in China: a multi-center observational study. Acta Anesth Scand 2009; 53: 873-82.
- Johansen JW, Sebel PS. Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology 2000; 93: 1336
- Struys M, Versichelen L, Byttebier G, Mortier E, Moerman A, Rolly G. Clinical usefulness of the bispectral index for titrating propofol target effect-site concentration. Anaesthesia 1998; 53: 4-12.
- White PF, Tang J, Romero GF, Wender RH, Naruse R, Sloninsky A, Kariger R. A comparison of state and response entropy versus bispectral index values during the perioperative period. Anesth Analg 2006; 102: 160-7.
- Burrow B, McKenzie B, Case C. Do anaesthetized patients recover better after bispectral index monitoring? Anaesth Intensive Care 2001; 29: 239-45.
- Jensen EW, Litvan H, Revuelta M, Rodriguez BE, Caminal P, Martinez P, Vereecke H, Struys MM. Cerebral state index during propofol anesthesia: a comparison with the bispectral index and the A-line ARX index. Anesthesiology 2006; 105: 28-36.
- Bauer M, Wilhelm W, Kraemer T, Kreuer S, Brandt A, Adams HA, Hoff G, Larsen R. Impact of bispectral index monitoring on stress response and propofol consumption in patients undergoing coronary artery bypass surgery. Anesthesiology 2004; 101: 1096-104.
- Gan TJ, Glass PS, Windsor A, Payne F, Rosow C, Sebel P, Manberg P. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology 1997; 87: 808-15.
- Ibraheim O, Alshaer A, Mazen K, El-Dawlaty A, Turkistani A, Alkathery K, AlZahrani T, Al-Dohayan A, Bukhari A. Effect of bispectral index (BIS) monitoring on postoperative recovery and sevoflurane consumption among morbidly obese patients undergoing laparoscopic gastric banding. Middle East J Anesthesiol 2008; 19: 819-30.
- Johansen JW, Sebel PS, Sigl JC. Clinical impact of hypnotic-titration guidelines based on EEG bispectral index (BIS) monitoring during routine anesthetic care. J Clinical Anesth 2000; 12: 433-43.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 23 Mayıs 2013 |
| Yayımlandığı Sayı | Yıl 2013Cilt: 35 Sayı: 3 |