Effect of Monitoring with Bispectral Index (BIS) on Depth of Anesthesia and Recovery in Sevoflurane and Isoflurane Anesthesia
Öz
Aim
We aimed to evaluate the effect of bispectral index (BIS) monitoring on anesthesia depth and recovery in patients undergoing thoracic surgery under sevoflurane and isoflurane anesthesia.
Material Method
After the hospital ethics committee approval, sixty ASA class I-II and the ages between 20-60 years elective thoracotomy patients were randomly divided into four groups; Group 1: Sevoflurane-Control, Group 2: Sevoflurane-BIS, Group 3: Isoflurane-Control, and Group 4: Isoflurane-BIS. Invasive arterial pressure and BIS monitorization were performed with standard anesthesia guidelines. After midazolam premedication, standard anesthesia induction was performed. However, in the groups where BIS monitorization was performed, sevoflurane and isoflurane were adjusted to provide 45-55 BIS values during the operation and 60-75 in the last 15 minutes of the surgery. The initial parameters, BIS, end-tidal carbon dioxide (EtCO2), fractioned inspired volatile anesthetic concentration (FiVAC) end-tidal volatile anesthetic, minimum alveolar concentration (MAC) values, total additional fentanyl and vecuronium bromide doses, time to respond to a verbal stimulus after anesthetic gas was interrupted, durations of extubation, orientation, and recovery of the patients were recorded. In addition, they were asked whether they remembered anything about the operation 24 hours later postoperatively.
Results
No significant difference was found between intraoperative hemodynamic data, FİVAC, ETVAC, MAC values, and BIS values between the groups (p > 0.05). No difference was found from the point of view of time for response to verbal stimulus, extubation, orientation, and recovery between the control and BIS groups, and none of the subjects remembered anything about the operation 24 hours later postoperatively.
Conclusion
Our study showed that adequate depth of anesthesia was achieved in both the control and BIS groups BIS monitoring was not found to improve quality of awakening and recovery. It was thought that BIS monitoring might be useful for those with less clinical experience rather than for experienced anesthesiologists.
Anahtar Kelimeler
Kaynakça
- 1. Ziegler D, Papanas N, Vinik AI, et. al.Epidemiology of polyneuropathy in diabetes and prediabetes. Handb Clin Neurol. 2014;126:3-22. doi: 10.1016/B978-0-444-53480-4.00001-1. 1.Kissin I. Components of General Anesthesia: History of the Concept Transformation. Anesth Analg. 2023 Sep 14;137(3):702–7.
- 2. Brown EN, Pavone KJ, Naranjo M. Multimodal General Anesthesia: Theory and Practice. Anesth Analg. 2018 Nov;127(5):1246–58.
- 3. Shim JH. Multimodal analgesia or balanced analgesia: the better choice? Korean J Anesthesiol. 2020 Oct 1;73(5):361–2.
- 4. Oliveira CRD, Bernardo WM, Nunes VM. Benefit of general anesthesia monitored by bispectral index compared with monitoring guided only by clinical parameters. Systematic review and meta-analysis. Brazilian Journal of Anesthesiology (English Edition). 2017 Jan;67(1):72–84.
- 5. Froese L, Dian J, Gomez A, Batson C, Sainbhi AS, Zeiler FA. Association Between Processed Electroencephalogram-Based Objectively Measured Depth of Sedation and Cerebrovascular Response: A Systematic Scoping Overview of the Human and Animal Literature. Front Neurol. 2021 Aug 16;12.
- 6. Ling L, Yang TX, Lee SWK. Effect of Anaesthesia Depth on Postoperative Delirium and Postoperative Cognitive Dysfunction in High-Risk Patients: A Systematic Review and Meta-Analysis. Cureus. 2022 Oct 10;14(10):e30120. doi: 10.7759/cureus.30120.
- 7. Lewis SR, Pritchard MW, Fawcett LJ, Punjasawadwong Y. Bispectral index for improving intraoperative awareness and early postoperative recovery in adults. Cochrane Database Syst Rev. 2019 Sep 26;9(9):CD003843. doi: 10.1002/14651858.CD003843.pub4.
- 8. Aldrete JA. Modifications to the postanesthesia score for use in ambulatory surgery. J Perianesth Nurs. 1998 Jun;13(3):148-55. doi: 10.1016/s1089-9472(98)80044-0.
- 9. Aranake A, Mashour GA, Avidan MS. Minimum alveolar concentration: ongoing relevance and clinical utility. Anaesthesia. 2013 May 16;68(5):512–22.
- 10. Trillo-Urrutia L, Fernández-Galinski S, Castaño-Santa J. Awareness detected by auditory evoked potential monitoring. Br J Anaesth. 2003 Aug;91(2):290-2. doi: 10.1093/bja/aeg144.
- 11. Dershwitz M. Should we measure depth of anesthesia? Seminars in Anesthesia, Perioperative Medicine and Pain. 2001 Dec 1;20(4):246–56.
- 12. Kapoor MC. Depth of anesthesia monitoring in cardiac surgery-Standard of care soon? Ann Card Anaesth. 2020 Jul-Sep;23(3):260-261. doi: 10.4103/aca.ACA_141_19.
- 13. Gu Y, Hao J, Wang J, Liang P, Peng X, Qin X, Zhang Y, He D. Effectiveness Assessment of Bispectral Index Monitoring Compared with Conventional Monitoring in General Anesthesia: A Systematic Review and Meta-Analysis. Anesthesiol Res Pract. 2024 Aug 7;2024:5555481. doi: 10.1155/2024/5555481.
- 14. Chhanwal H, Kheskani D, Gandhi P, Shah MB, Makwana D, Rathod V. Bispectral index: the current tool for monitoring unintended awareness and depth of anesthesia. Ain-Shams Journal of Anesthesiology. 2022 Oct 15;14(1):74.
- 15. Gökahmetoglu G. Comparison of the depth of anesthesia in sevoflurane and halothane anesthesia with bispectral index and 95% spectral edge frequency. Dicle Medical Journal/Dicle Tıp Dergisi. 2013 Sep 1;40(3):350–6. 16. Ganidağlı S, Demirbilek S, Baysal Z. Anestezi derinliği ve bispektral indeks monitorizasyonu. 2001;9(4):260–4.
Öz
Kaynakça
- 1. Ziegler D, Papanas N, Vinik AI, et. al.Epidemiology of polyneuropathy in diabetes and prediabetes. Handb Clin Neurol. 2014;126:3-22. doi: 10.1016/B978-0-444-53480-4.00001-1. 1.Kissin I. Components of General Anesthesia: History of the Concept Transformation. Anesth Analg. 2023 Sep 14;137(3):702–7.
- 2. Brown EN, Pavone KJ, Naranjo M. Multimodal General Anesthesia: Theory and Practice. Anesth Analg. 2018 Nov;127(5):1246–58.
- 3. Shim JH. Multimodal analgesia or balanced analgesia: the better choice? Korean J Anesthesiol. 2020 Oct 1;73(5):361–2.
- 4. Oliveira CRD, Bernardo WM, Nunes VM. Benefit of general anesthesia monitored by bispectral index compared with monitoring guided only by clinical parameters. Systematic review and meta-analysis. Brazilian Journal of Anesthesiology (English Edition). 2017 Jan;67(1):72–84.
- 5. Froese L, Dian J, Gomez A, Batson C, Sainbhi AS, Zeiler FA. Association Between Processed Electroencephalogram-Based Objectively Measured Depth of Sedation and Cerebrovascular Response: A Systematic Scoping Overview of the Human and Animal Literature. Front Neurol. 2021 Aug 16;12.
- 6. Ling L, Yang TX, Lee SWK. Effect of Anaesthesia Depth on Postoperative Delirium and Postoperative Cognitive Dysfunction in High-Risk Patients: A Systematic Review and Meta-Analysis. Cureus. 2022 Oct 10;14(10):e30120. doi: 10.7759/cureus.30120.
- 7. Lewis SR, Pritchard MW, Fawcett LJ, Punjasawadwong Y. Bispectral index for improving intraoperative awareness and early postoperative recovery in adults. Cochrane Database Syst Rev. 2019 Sep 26;9(9):CD003843. doi: 10.1002/14651858.CD003843.pub4.
- 8. Aldrete JA. Modifications to the postanesthesia score for use in ambulatory surgery. J Perianesth Nurs. 1998 Jun;13(3):148-55. doi: 10.1016/s1089-9472(98)80044-0.
- 9. Aranake A, Mashour GA, Avidan MS. Minimum alveolar concentration: ongoing relevance and clinical utility. Anaesthesia. 2013 May 16;68(5):512–22.
- 10. Trillo-Urrutia L, Fernández-Galinski S, Castaño-Santa J. Awareness detected by auditory evoked potential monitoring. Br J Anaesth. 2003 Aug;91(2):290-2. doi: 10.1093/bja/aeg144.
- 11. Dershwitz M. Should we measure depth of anesthesia? Seminars in Anesthesia, Perioperative Medicine and Pain. 2001 Dec 1;20(4):246–56.
- 12. Kapoor MC. Depth of anesthesia monitoring in cardiac surgery-Standard of care soon? Ann Card Anaesth. 2020 Jul-Sep;23(3):260-261. doi: 10.4103/aca.ACA_141_19.
- 13. Gu Y, Hao J, Wang J, Liang P, Peng X, Qin X, Zhang Y, He D. Effectiveness Assessment of Bispectral Index Monitoring Compared with Conventional Monitoring in General Anesthesia: A Systematic Review and Meta-Analysis. Anesthesiol Res Pract. 2024 Aug 7;2024:5555481. doi: 10.1155/2024/5555481.
- 14. Chhanwal H, Kheskani D, Gandhi P, Shah MB, Makwana D, Rathod V. Bispectral index: the current tool for monitoring unintended awareness and depth of anesthesia. Ain-Shams Journal of Anesthesiology. 2022 Oct 15;14(1):74.
- 15. Gökahmetoglu G. Comparison of the depth of anesthesia in sevoflurane and halothane anesthesia with bispectral index and 95% spectral edge frequency. Dicle Medical Journal/Dicle Tıp Dergisi. 2013 Sep 1;40(3):350–6. 16. Ganidağlı S, Demirbilek S, Baysal Z. Anestezi derinliği ve bispektral indeks monitorizasyonu. 2001;9(4):260–4.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Anesteziyoloji |
| Bölüm | Original Article |
| Yazarlar | |
| Erken Görünüm Tarihi | 28 Nisan 2025 |
| Yayımlanma Tarihi | 1 Mayıs 2025 |
| Gönderilme Tarihi | 21 Mart 2025 |
| Kabul Tarihi | 28 Mart 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 1 Sayı: 1 |
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