British Journal of Anaesthesia, Vol 84, Issue 1 33-37, Copyright © 2000 by Oxford University Press
O Detsch, G Schneider, E Kochs, G Hapfelmeier and C Werner
We have studied the effects of increases in isoflurane concentration on the
EEG bispectral index (BIS) in 70 patients anaesthetized with
isoflurane-nitrous oxide-sufentanil for major abdominal surgery. During
surgery, baseline BIS was recorded at 0.8% end-tidal isoflurane with
nitrous oxide in oxygen (FIO2 0.35). After this, end-tidal isoflurane was
increased to 1.6% for 15 min and decreased subsequently to 0.8% for 20 min
to assess recovery. In 20 patients, BIS decreased from a mean value of 40
(SD 9) during baseline to 25 (10) at 1.6% isoflurane. In contrast, BIS did
not change in 23 patients and increased in 27 patients from 35 (6) to 46
(8) as isoflurane was increased to 1.6%. In all patients, BIS recovered to
baseline values at 0.8% isoflurane. The changes in BIS with increasing
isoflurane concentration were not related to drugs or differences in
physiological variables, which did not differ between groups. Patients with
a decrease in BIS were significantly younger (38 (range 18-68) yr) than
those with unchanged (55 (26-70) yr) or increased (60 (40-70) yr) BIS
values (P < 0.001). It is possible that the paradoxical increase in BIS
is related to continuous pre-burst EEG patterns consisting of
high-frequency activity. This suggests that the use of BIS as a guide for
isoflurane administration may be misleading in some patients undergoing
surgical procedures.
ARTICLES
Increasing isoflurane concentration may cause paradoxical increases in the EEG bispectral index in surgical patients
Klinik fur Anaesthesiologie, Klinikum rechts der Isar, Technische Universitat Munchen, Germany.
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