Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.07.003
Brazilian Journal of Anesthesiology
Miscellaneous

Correlation of bispectral index (BIS) monitoring and end-tidal sevoflurane concentration in a patient with lobar holoprosencephaly

Correlação entre monitoração do índice bispectral (BIS) e concentração expirada de sevoflurano em paciente com holoprosencefalia lobar

Dario Galante; Donatella Fortarezza; Maria Caggiano; Giovanni de Francisci; Dino Pedrotti; Marco Caruselli

http://dx.doi.org/10.1016/j.bjane.2014.07.003 Braz J Anesthesiol, vol.65, n5, p.379-383, 2015
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Abstract

ABSTRACTOBJECTIVE: The bispectral index (BIS) is a parameter derived by electroencephalography (EEG) which provides a direct measurement of the effects of sedatives and anesthetics on the brain and offers guidance on the adequacy of anesthesia. The literature lacks studies on BIS monitoring in pediatric patients with congenital brain disease undergoing general anesthesia.CLINICAL FEATURES: A 13-year-old child weighing 32 kg, suffering from lobar holoprosencephaly, underwent surgery in which the bispectral index (BIS) monitoring the depth of anesthesia showed an abnormal response. Detailed analysis of the trends of BIS values in the different observation times demonstrated sudden falls and repetitive values of BIS likely related to repetitive epileptiform electrical activity caused by sevoflurane.CONCLUSION: The BIS is a very useful monitoring tool for assessing the degree of depth of anesthesia and to analyze the electroencephalographic variations of anesthetics. Particular attention should be given to patients with congenital disorders of the central nervous system in which the BIS may give abnormal responses that do not reflect an accurate assessment of the depth of anesthesia.

Keywords

Holoprosencephaly, Bispectral index, Sevoflurane, Seizures

Resumo

RESUMOOBJETIVO: O índice bispectral (BIS) é um parâmetro derivado por eletroencefalografia (EEG) que fornece uma medida direta dos efeitos de sedativos e anestésicos no cérebro e orientação sobre a adequação da anestesia. A literatura carece de estudos sobre a monitoração do BIS em pacientes pediátricos com doença cerebral congênita submetidos à anestesia geral.CARACTERÍSTICAS CLÍNICAS: Criança de 13 anos de idade, pesando 32 kg, com holoprosencefalia lobar, foi submetida à cirurgia em que a monitoração da profundidade da anestesia com o uso do BIS mostrou uma resposta anormal. A análise detalhada das tendências dos valores do BIS nos diferentes tempos de observação mostrou quedas súbitas e valores repetitivos do BIS, provavelmente relacionados à atividade elétrica epileptiforme repetitiva causada por sevoflurano.CONCLUSÃO: O BIS é uma ferramenta de monitoração muito útil para avaliar o grau de profundidade da anestesia e as variações eletroencefalográficas dos anestésicos. Atenção especial deve ser dedicada aos pacientes com doenças congênitas do sistema nervoso central nos quais o BIS pode apresentar respostas anormais que não refletem a avaliação precisa da profundidade da anestesia.

Palavras-chave

Holoprosencefalia, Índice bispectral, Sevoflurano, Convulsões

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