Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2019.04.006
Brazilian Journal of Anesthesiology
Scientific Article

Evaluation of Bispectral Index time delay in response to anesthesia induction: an observational study

Avaliação do tempo de atraso do índice bispectral na resposta à indução da anestesia: estudo observacional

Ana Leitão Ferreira, Joaquim Gabriel Mendes, Catarina Sofia Nunes, Pedro Amorim

Downloads: 4
Views: 900

Abstract

Background and objectives: According to the manufacturer, the Bispectral Index (BIS) has a processing time delay of 5---10 s. Studies addressing this have suggested longer delays. We evaluated the time delay in the Bispectral Index response. Methods: Based on clinical data from 45 patients, using the difference between the predicted and the real BIS, calculated during a fixed 3 minutes period after the moment the Bispectral Index dropped below 80 during the induction of general anesthesia with propofol and remifentanil. Results: The difference between the predicted and the real BIS was in average 30.09 ± 18.73 s. Conclusion: Our results may be another indication that the delay in BIS processing may be much longer than stated by the manufacture, a fact with clinical implications

Keywords

Bispectral index monitor; Depth of anesthesia; Awareness; Time delay

Resumo

Justificativa e objetivos: De acordo com o fabricante, o índice bispectral (BIS) tem um tempo de processamento de cinco a dez segundos. Estudos que avaliaram esse tempo de processamento sugeriram atrasos mais longos. Nós avaliamos o tempo de atraso na resposta do BIS. Métodos: Com base em dados clínicos de 45 pacientes, calculamos a diferenc¸a entre o tempo de atraso previsto e real do índice bispectral durante um período fixo de três minutos após o momento em que o BIS caiu abaixo de 80 durante a induc¸ão da anestesia geral com propofol e remifentanil. Resultados: A diferenc¸a entre o BIS previsto e real foi em média 30,09 ± 18,73 segundos. Conclusão: Nossos resultados sugerem que o atraso no processamento do índice bispectral pode ser muito maior que o declarado pelo fabricante, um fato com implicac¸ões clínicas.

Palavras-chave

Monitor do índice bispectral; Profundidade da anestesia; Consciência; Tempo de atraso

References

1. Lobo FA, Schraag S. Limitations of anaesthesia depth monitoring. Curr Opin Anaesthesiol. 2011;24:657---64.

2. Dahaba AA. Different conditions that could result in the bispectral index indicating an incorrect hypnotic state. Anesth Analg. 2005;101:765---73.

3. Covidien. [Online]. Available: http://www.covidien.com/rms/ brands/BIS.

4. Nunes RR, Chaves IM, de Alencar JC, et al. Bispectral index and other processed parameters of electroencephalogram: an update. Rev Bras Anestesiol. 2012;62:105---17.

5. Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology. 1998;89:980---1002.

6. Dryden J. Preventing memories of surgery 2011. [Online]. Available: https://www.youtube.com/watch?v=fHAkVSyOym8.

7. Lang J. Awakening Atl.; 2013.

8. Zanner R, Pilge S, Kochs EF, et al. Time delay of electroencephalogram index calculation: analysis of cerebral state, bispectral, and Narcotrend indices using perioperatively recorded electroencephalographic signals. Br J Anaesth. 2009;103:394---9.

9. Pilge S, Zanner R, Schneider G, et al. Time delay of index calculation: analysis of cerebral state, bispectral, and narcotrend indices. Anesthesiology. 2006;104:488---94.

10. Ferreira AIL, Nunes CS, Gabriel J, et al. The influence of two different drug infusion profiles on the pharmacodynamics model performance. In: Jaffray D, editor. World congress on medical physics and biomedical engineering, June 7---12, 51. Toronto, Canada: IFMBE Proceedings; 2015. p. 874---80.

11. Minto CF, Schnider TW, Short TG, et al. Response surface model for anesthetic drug interactions. Anesthesiology. 2000;92:1603---16.

12. Chernik DA, Gillings D, Laine H, et al. Validity and reliability of the Observer’s Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol. 1990;10:244---51.

13. Schnider TW, Minto CF, Gambus PL, et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology. 1998;88:1170---82.

14. Minto CF, Schnider TW, Egan TD, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology. 1997;86:10---23.

15. Minto CF, Schnider TW, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil. II. Model application. Anesthesiology. 1997;86:24---33.

16. Bruhn J, Bouillon TW, Radulescu L, et al. Correlation of approximate entropy, bispectral index, and spectral edge frequency 95 (SEF95) with clinical signs of ‘‘anesthetic depth’’ during coadministration of propofol and remifentanil. Anesthesiology. 2003;98:621---7.

17. Shepherd J, Jones J, Frampton GK, et al. Clinical effectiveness and cost-effectiveness of depth of anaesthesia monitoring (E-Entropy, Bispectral Index and Narcotrend): a systematic review and economic evaluation. Health Technol Assess (Rockv). 2013;17:1---124.

18. Purdon PL, Pavone KJ, Akeju O, et al. The Ageing Brain: age-dependent changes in the electroencephalogram during propofol and sevoflurane general anaesthesia. Br J Anaesth. 2015;115:i46---57.

19. Myles PS, Williams DL, Hendrata M, et al. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84:6---10.

20. Leslie K, Chan MTV, Myles PS, et al. Posttraumatic stress disorder in aware patients from the B-Aware trial. Anesth Analg. 2010;110:823---8.

21. Myles PS, Leslie K, McNeil J, et al. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004;363:1757---63.

22. Johansen JW. Update on bispectral index monitoring. Best Pract Res Clin Anaesthesiol. 2006;20:81---99.

23. Luginbühl M, Schnider TW. Detection of awareness with the bispectral index: two case reports. Anesthesiology. 2002;96: 241---3.

24. Leslie K, Myles PS, Forbes A, et al. The effect of bispectral index monitoring on long-term survival in the B-aware trial. Anesth Analg. 2010;110:816---22.

25. Kertai MD, Pal N, Palanca BJA, et al. Association of perioperative risk factors and cumulative duration of low bispectral index with intermediate-term mortality after cardiac surgery in the b-unaware trial. Anesthesiology. 2010;112: 1116---27.

26. Lindholm M-L, Träff S, Granath F, et al. Mortality within 2 years after surgery in relation to low intraoperative bispectral index values and preexisting malignant disease. Anesth Analg. 2009;108:508---12.

5daa09e00e8825d80f65eae2 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections