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BJA Advance Access published online on August 23, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael235
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted July 7, 2006

Clinical Investigation

Bispectral index is a topographically dependent variable in patients receiving propofol anaesthesia

P. Pandin 1 *, N. Van Cutsem 1, T. Tuna 1, and A. D'hollander 2

1 Department of Anesthesiology, Erasmus Hospital, Free University of Brussels, Brussels, Belgium
2 Division of Anesthesiology, Cantonal University Hospital, Geneva, Switzerland

* To whom correspondence should be addressed.
P. Pandin, E-mail: ppandin{at}ulb.ac.be


  Abstract

Background. As very strong agreement has been reported between bispectral index (BIS) values measured from the occipital and frontal skull areas, we compared BIS values measured from central and parietal areas with those from frontal area to investigate whether BIS is really a topographically dependent or topographically independent variable.

Methods. Twenty patients, ASA I-II, non-obese, aged 18-62 yr and with no neurological disorders were enrolled. Based on the 10-20 international landmarks, five silver dome electrodes were positioned: F7, C3, P7, Cz (common reference) and Fp1 (ground). Using frontal (F7-Cz), central (C3-Cz) and parietal (P7-Cz) electrode montages, the corresponding BIS values were simultaneously recorded with an Aspect A-1000 monitor (software v3.12). The BIS values were recorded at the propofol concentration allowing laryngeal mask insertion, which was maintained during the 10 min data collection period in absence of additional external stimuli. Data were analysed using the Kruskall-Wallis, Wilcoxon paired sign with Bonferroni correction, Bland-Altman and linear correlation tests.

Results. At the predicted effect target propofol concentration 4-8 µg ml-1, the 10 min mean BIS (median [min-max]) were 32 [20-44], 46 [28-68] and 58 [41-72] for the frontal, central and parietal leads, respectively. Differences between these BIS recordings were statistically significant (P<0.0001, Kruskall-Wallis; P<0.005, Wilcoxon paired sign test).

Conclusions. The present results provide evidence that BIS index is a topographically dependent variable in patients receiving propofol anaesthesia.

Keywords: anaesthetics i.v., propofol; laryngeal mask insertion; monitoring, bispectral index.
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