BIS values during resuscitation: the role of the suppression ratio (case report)

Abstract

We report a case during which it was simultaneously recorded usual Bispectral Index (BIS) values and elevated suppression ratio (SR) during resuscitation maneuvers. A 52-year-old woman, scheduled for a suspension laryngoscopy, required cardio-pulmonary resuscitation due to an anaphylactic shock secondary to the administration of succinylcholine. Post-crisis analysis of the BIS trace showed both BIS numbers consistent with an adequate level hypnosis and an increase in SR. Simultaneous hypnotic BIS values and an elevated SR is striking as SR quantifies electroenceph- alographic suppression. Clinicians must remember that SR is one of the parameters incorporated into BIS and must take SR into account even when the BIS is within the target range.

Brain burst suppression activity.

“…A BSP not only appears under the effect of anesthetics; it has also been reported in comatose patients after traumatic brain injury, hypoglycemic coma, hypoxemia, vascular brain injury, cases of overdose of drugs that depress central nervous system activity, profound hypothermia, anoxic-ischemic encephalopathy after cardio-respiratory arrest, patients with any severe diffuse encephalopathy, and during any stage of neonatal sleep (De Rubeis & Young, 2001; Declerck, Liu, Chazot, & Fischler, 2009; Hayashida et al, 2007; Johansen, 2001; Levy, Pantin, Mehta, & McGarvey, 2003; N. Liu, Chazot, Mutter, & Fischler, 2006; Marion et al, 1997; Michenfelder & Milde, 1991; Myles & Cairo, 2004; Nakashima, Todd, & Warner, 1995; Ernst Niedermeyer & Lopes Da Silva, 2005; E.…”

Remifentanil Alleviates Propofol-Induced Burst Suppression without Affecting Bispectral Index in Female Patients: A Randomized Controlled Trial

“…Also, the burst suppression ratio, derived from BIS monitoring, is correlated with the burst suppression and could be an indicator of anesthesia that is too deep [14]. Several reports have suggested that the burst suppression ratio is associated with intraoperative metabolic disorders or brain injury [15,16,17], and postoperative prognosis and delirium [18,19,20].…”