Bispectral index values during elective rigid bronchoscopy: a prospective observational pilot study

Abstract

SummaryRigid bronchoscopy is associated with a high incidence of haemodynamic disturbance and awareness under anaesthesia. Anaesthetic agents are given both to attenuate the sympathetic response to bronchoscopy and to prevent awareness. Use of the Bispectral index to guide anaesthesia has shown to reduce awareness and improve recovery times from general anaesthesia. We undertook a prospective observational study of BIS values in 50 patients during routine anaesthesia for rigid bronchoscopy. BIS values were found to be between 40-60 during bronchoscopy for only 0.5% of the time (0-11.5% [0-98.7%]), median (interquartile range [range]). Patients had a BIS < 40 for 99.6% (87.9-100% [0-100%]) of the duration of bronchoscopy. We identified one case of possible awareness. Few of our patients undergoing general anaesthesia for rigid bronchoscopy had BIS scores in the suggested range of between 40 and 60. BIS < 40 was more frequent than in previous studies of different surgical populations. There was no difference in the BIS values of patients anaesthetised with intermittent boluses or target controlled infusions of propofol.

How is sedation provided for percutaneous dilatational tracheostomy in English ICUs?

“…In seven units (3.3%) anaesthesia is provided using intermittent boluses of propofol, without a background infusion. This may be of concern given that one study reported awareness during rigid bronchoscopies [3] and all the patients who reported awareness were anaesthetized using intermittent boluses of propofol. Nine units (4.2%) reported using a BIS during PDT.…”

Remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy: comparison of adjuvant propofol and ketamine

“…Intermittent propofol injections instead of continuous infusion during rigid bronchoscopy may be preferred as a practical technique in some centers (17,28), as in our institution. In this study, to decrease the recovery time and risk of awareness, propofol or ketamine infusions instead of bolus doses and bispectral index monitoring may be more appropriate.…”

“…In this study, to decrease the recovery time and risk of awareness, propofol or ketamine infusions instead of bolus doses and bispectral index monitoring may be more appropriate. However, Bould et al (28) found no difference in the bispectral index (BIS) values of patients anesthetized for elective RB with intermittent boluses or target controlled infusions of propofol. In addition, bispectral index monitoring was found to be unreliable in the case of ketamine use (29).…”

Automatic administration of propofol and remifentanil guided by the bispectral index during rigid bronchoscopic procedures: a randomized trial

“…12 Then again, in an observational study of patients during routine anesthesia for rigid bronchoscopy, Bould et al 2 reported that Manual TCI = manual target-control infusion of propofol and remifentanil guided by the bispectral index. Dual-loop = Automated control of propofol and remifentanil guided by the bispectral index BIS = bispectral index; BIS 40-60 = percentage of time during which the BIS value was 40-60 during the maintenance; BIS \40 = percentage of time during which the BIS value was less than a value of 40; BIS [60 = percentage of time during which the BIS value was greater than a value of 60; SR = burst suppression ratio incidence (i.e., patients who presented a suppression ratio [ 10% during more than one minute) PE = performance error; MDPE = median of performance error or bias; MDAPE = median absolute performance error or inaccuracy; Wobble = intra-individual variability in performance error; GS = global score Automatic administration of propofol-remifentanil 885 usual, as they knew that patients would be interviewed postoperatively to determine explicit recall.…”

“…2 Recently, we described a controller that appears to be effective for anesthetic induction and maintenance during common surgical procedures. 3 Rigid bronchoscopy is a particularly challenging procedure.…”