Bispectral index monitoring in patients undergoing open heart surgery

Abstract Introduction: To obtain the optimal anesthesia depth is not easy in cardiovascular surgery patients where the haemodynamic reserve is limited, due to reasons such as not being able to give the desired dose of anesthetic agent, or the change in the pharmacokinetics of the agent in the heart-lung machine. This study was planned to assess the contribution of bispectral index (BIS) monitoring in the depth of anesthesia. Methods: The patients were divided into 2 groups, and BIS monitoring was used for each patient. Group 1 (G1 n=35): keeping the BIS monitor screen open, the anesthesia need was set. Group 2 (G2 n=35): BIS monitor was tied to the patient and the monitor screen was closed in such a way that the anaesthesist couldn't see the BIS value. When the recording time came, the data on the monitor was recorded. The need for the anesthetic agent was set according to the parameters such as haemodynamics or follow up of pupils, instead of BIS value, by titrating the anesthetic infusion doses. Results: BIS values were similar in both groups before the induction, BIS values in both groups showed a decrease, showing no significant statistical difference (P>0.05). One patient in each group said that he dreamt, and one patient in G2 said that he had heard a noise and felt that he was taken from one place to another. Conclusion: The management should be done with clinical evaluation, haemodynamics and other monitorization methods and BIS monitoring findings together.

A influência do índice bispectral no tempo de alta hospitalar de pacientes submetidos a procedimentos oftalmológicos / The influence of the bispectral index in hospital time of patients undergoing ophthalmic procedures

Objetivo do estudo: avaliar se a titulação de drogas guiada pelo índice bispectral em pacientes submetidos à cirurgia oftalmológica ambulatorial está associada a uma redução no tempo de alta. Método: foram selecionados 111 pacientes submetidos a procedimentos oftalmológicos realizados sob sedação intravenosa associada ao bloqueio peribulbar. Ospacientes foram randomizados em dois grupos. Nos pacientes do grupo controle, o anestesista responsável administrou a sedação de acordo com parâmetros clínicos: manter o paciente entre 2 a 4 pontos na escala de sedação de Ramsay. No outro grupo, o índice bispectral foi monitorizado e a sedação foi administrada para manter os valores entre 70 e 85. Foram comparados entre os grupos os dados demográficos, a dosagem de drogas, a duração dos procedimentos, as complicações pós-operatórias e o tempo de alta. Resultados: os grupos não apresentaram diferenças estatísticas em relação aos dados demográficos, à dosagem das drogas intravenosas e à dose administrada de anestésico local. Não se observou diferença entre os grupos em relação à duração dos procedimentos e ao tempo de alta para casa. As complicações pós-operatórias detectadas foram náuseas e vômitos e dor pós-operatória, no entanto, sem diferença estatística significante entre os grupos. Conclusões: a monitorização com o índice bispectral não foi mais eficaz que à monitorização clínica, em reduzir o tempo de alta para casa de pacientes submetidos a cirurgias oftalmológicas ambulatoriais sob sedação e bloqueio peribulbar.

Study objective: assessing whether drug titration guided by the bispectral index in patients submitted to outpatient ophthalmological surgeries is associated with a decreased time of hospital discharge. Method: one hundred and eleven patients submitted to outpatient ophthalmological procedures performed under intravenous sedation associated with peribulbar block were selected for this study. Patients were randomized in two groups. In the control group, the anesthetist in charge administered sedation according to clinical parameters: maintaining the patient between 2 and 4 points in the Ramsay?s sedation scale. In the other group, the bispectral index was monitored and sedation was performed with the purpose of maintaining its values between 70 and 85. Demographic data, drug dosage, length of procedures, post-surgical complications and time of hospital discharge were compared between the two groups. Results: groups have not shown statistical differences regarding demographic data, dosage of intravenous drugs and the dosage of local anesthetic administered. No difference was observed between groups regarding the length of the procedures, and the time of hospital discharge. The post-surgical complications detected were nausea and vomiting and post-surgical pain, however, with no statistically significant difference between groups. Conclusions: bispectral index monitoring has not been more effective than clinical monitoring to reduce the time of hospital discharge of patients submitted to outpatient ophthalmological surgeries under sedation and peribulbar block.