Bispektral İndeks (BIS) ile total intravenöz anestezi derinliği izlemi; propofol ajan tüketimi, derlenme kriterleri ve farkında olmaya etkisi

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.

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 index