Más sobre BIS/More on BIS

Septiembre 19, 2015. No. 2090

Efecto del monitoreo BIS sobre los requerimientos de anestesia en TCI para microdiscectomía lumbar The effect of bispectral index monitoring on anaesthetic requirements in target-controlled infusion for lumbar microdiscectomy. Karwacki Z, Niewiadomski S, Rzaska M, Witkowska M. Anaesthesiol Intensive Ther. 2014 Sep-Oct;46(4):284-8. doi: 10.5603/AIT.2014.0046. CONCLUSION: BIS monitoring reduces the doses of opioids and hypnotics used during total intravenous anaesthesia by TCI. PDF Monitoreo BIS durante sedación con propofol y remifentanil para disección endoscópica submucosa. Bispectral index monitoring during anesthesiologist-directed propofol and remifentanil sedation for endoscopic submucosal dissection: a prospective randomized controlled trial. Park WY, Shin YS, Lee SK, Kim SY, Lee TK, Choi YS. Yonsei Med J. 2014 Sep;55(5):1421-9. doi: 10.3349/ymj.2014.55.5.1421. Abstract PURPOSE: Endoscopic submucosal dissection (ESD) is a technically difficult and lengthy procedure requiring optimal depth of sedation. The bispectral index (BIS) monitor is a non-invasive tool that objectively evaluates the depth of sedation. The purpose of this prospective randomized controlled trial was to evaluate whether BIS guided sedation with propofol and remifentanil could reduce the number of patients requiring rescue propofol, and thus reduce the incidence of sedation- and/or procedure-related complications. MATERIALS AND METHODS: A total of 180 patients who underwent the ESD procedure for gastric adenoma or early gastric cancer were randomized to two groups. The control group (n=90) was monitored by the Modified Observer's Assessment of Alertness and Sedation scale and the BIS group (n=90) was monitored using BIS. The total doses of propofol and remifentanil, the need for rescue propofol, and the rates of complications were recorded. RESULTS: The number of patients who needed rescue propofol during the procedure was significantly higher in the control group than the BIS group (47.8% vs. 30.0%, p=0.014). There were no significant differences in the incidence of sedation- and/or procedure-related complications. CONCLUSION: BIS-guided propofol infusion combined with remifentanil reduced the number of patients requiring rescue propofol in ESD procedures. However, this finding did not lead to clinical benefits and thus BIS monitoring is of limited use during anesthesiologist-directed sedation. KEYWORDS: Bispectral index; endoscopic submucosal dissection; propofol; remifentanil PDF    BIS en la detección de dolor en pacientes adultos con ventilación mecánica en UCI The use of the bispectral index in the detection of pain in mechanically ventilated adults in the intensive care unit: a review of the literature. Coleman RM, Tousignant-Laflamme Y, Ouellet P, Parenteau-Goudreault É, Cogan J, Bourgault P. Pain Res Manag. 2015 Jan-Feb;20(1):e33-7. Epub 2014 Jul 22. Abstract BACKGROUND: Pain assessment is an immense challenge for clinicians, especially in the context of the intensive care unit, where the patient is often unable to communicate verbally. Several methods of pain assessment have been proposed to assess pain in this environment. These include both behavioural observation scales and evaluation of physiological measurements such as heart rate and blood pressure. Although numerous validation studies pertaining to behavioural observation scales have been published, several limitations associated with using these measures for pain assessment remain. Over the past few years, researchers have been interested in the use of the bispectral index monitoring system as a proxy for the evaluation of encephalography readings to assess the level of anesthesia and, potentially, analgesia. OBJECTIVES: To synthesize the main studies exploring the use of the bispectral index monitoring system for pain assessment, to guide future research in adults under sedation in the intensive care unit. METHOD: The EMBASE, Medline, CINAHL and PsycINFO databases were searched for studies published between 1996 and 2013 that evaluated the use of the bispectral index in assessing pain. RESULTS: Most studies conclude that nociceptive stimulation causes a significant increase in the bispectral index and revealed the importance of controlling certain confounding variables such as the level of sedation. DISCUSSION: Further studies are needed to clearly demonstrate the relationship between nociceptive stimuli and the bispectral index, as well as the specificity of the bispectral index in detecting pain. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Monitoreo BIS/BIS monitoring

Septiembre 20, 2015. No. 2091

BIS para mejorar la anestesia y el período postoperatorio Bispectral index for improving anaesthetic delivery and postoperative recovery. Punjasawadwong Y, Phongchiewboon A, Bunchungmongkol N. Cochrane Database Syst Rev. 2014 Jun 17;6:CD003843. doi: 10.1002/14651858.CD003843.pub3. Abstract BACKGROUND: The use of clinical signs may not be reliable in measuring the hypnotic component of anaesthesia. The use of bispectral index (BIS) to guide the dose of anaesthetic may have certain advantages over clinical signs. This is the second update of a review originally published in 2007. OBJECTIVES: The primary objective of this review focused on whether the incorporation of BIS into the standard practice for management of anaesthesia can reduce the risk of intraoperative awareness, consumption of anaesthetic agents, recovery time and total cost of anaesthesia in surgical patients undergoing general anaesthesia. SEARCH METHODS: In this updated version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE (1990 to 31 January 2013), EMBASE (1990 to 31 January 2013) and reference lists of articles. Previously, we searched to May 2009. SELECTION CRITERIA: We included randomized controlled trials comparing BIS with standard practice criteria for titration of anaesthetic agents. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality, extracted data and analysed the data. We contacted study authors for further details. MAIN RESULTS: We included 36 trials. In studies using clinical signs as standard practice, the results demonstrated a significant effect of the BIS-guided anaesthesia in reducing the risk of intraoperative awareness among surgical patients at high risk for awareness (7761 participants; odds ratio (OR) 0.24, 95% confidence interval (CI) 0.12 to 0.48). This effect was not demonstrated in studies using end tidal anaesthetic gas (ETAG) monitoring as standard practice (26,530 participants; OR 1.13, 95% CI 0.56 to 2.26). BIS-guided anaesthesia reduced the requirement for propofol by 1.32 mg/kg/hr (672 participants; 95% CI -1.91 to -0.73) and for volatile anaesthetics (desflurane, sevoflurane, isoflurane) by 0.65 minimal alveolar concentration equivalents (MAC) (95% CI -1.01 to -0.28) in 985 participants. Irrespective of the anaesthetics used, BIS reduced the following recovery times: time for eye opening (2557 participants; by 1.93 min, 95% CI -2.70 to -1.16), response to verbal command (777 participants; by 2.73 min, 95% CI -3.92 to -1.54), time to extubation (1501 participants; by 2.62 min, 95% CI -3.46 to -1.78), and time to orientation (373 participants; by 3.06 min, 95% CI -3.63 to -2.50). BIS shortened the duration of postanaesthesia care unit stay by 6.75 min (1953 participants; 95% CI -11.20 to -2.31) but did not significantly reduce the time to home readiness (329 participants; -7.01 min, 95% CI -30.11 to 16.09). AUTHORS' CONCLUSIONS: BIS-guided anaesthesia can reduce the risk of intraoperative awareness in surgical patients at high risk for awareness in comparison to using clinical signs as a guide for anaesthetic depth. BIS-guided anaesthesia and ETAG-guided anaesthesia may be equivalent in protection against intraoperative awareness but the evidence for this is inconclusive. In addition, anaesthesia guided by BIS kept within the recommended range improves anaesthetic delivery and postoperative recovery from relatively deep anaesthesia.   PDF   Capnografía y BIS en sedación pediátrica Capnography and the bispectral index-their role in pediatric sedation: a brief review. Sammartino M, Volpe B, Sbaraglia F, Garra R, D'Addessi A. Int J Pediatr. 2010;2010:828347. doi: 10.1155/2010/828347. Epub 2010 Oct 3. Abstract Sedation in children is increasingly emerging as a minimally invasive technique that may be associated with local anaesthesia or diagnostic and therapeutic procedures which do not necessarily require general anaesthesia. Standard monitoring requirements are not sufficient to ensure an effective control of pulmonary ventilation and deep sedation. Capnography in pediatric sedation assesses the effect of different drugs on the occurrence of respiratory failure and records early indicators of respiratory impairment. The Bispectral index (BIS) allows the reduction of dose requirements of anaesthetic drugs, the reduction in the time to extubation and eye opening, and the reduction in the time to discharge. In the field of pediatric sedation, capnography should be recommended to prevent respiratory complications, particularly in spontaneous ventilation. The use of the BIS index, however, needs further investigation due to a lack of evidence, especially in infants. In this paper, we will investigate the role of capnography and the BIS index in improving monitoring standards in pediatric sedation. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Sismo del 19 de septiembre de 1985 , 7:19 AM cd de México..

Monitoreo intraoperatorio con BIS y tiempo de extubación después de cirugía cardiaca. Análisis secundario de un estudio randomizado

Septiembre 18, 2015. No. 2089

Monitoreo intraoperatorio con BIS y tiempo de extubación después de cirugía cardiaca. Análisis secundario de un estudio randomizado Intraoperative bispectral index monitoring and time to extubation after cardiac surgery: secondary analysis of a randomized controlled trial. Vance JL, Shanks AM1, Woodrum DT. BMC Anesthesiol. 2014 Sep 18;14:79. doi: 10.1186/1471-2253-14-79. eCollection 2014. PDF Monitoreo cerebral con electroencefalografía y el electroencefalograma derivado del BIS durante cirugía cardiaca Brain monitoring with electroencephalography and the electroencephalogram-derived bispectral index during cardiac surgery. Kertai MD1, Whitlock EL, Avidan MS. Anesth Analg. 2012 Mar;114(3):533-46. doi: 10.1213/ANE.0b013e31823ee030. Epub 2012 Jan 17. Abstract Cardiac surgery presents particular challenges for the anesthesiologist. In addition to standard and advanced monitors typically used during cardiac surgery, anesthesiologists may consider monitoring the brain with raw or processed electroencephalography (EEG). There is strong evidence that a protocol incorporating the processed EEG bispectral index (BIS) decreases the incidence intraoperative awareness in comparison with standard practice. However, there is conflicting evidence that incorporating the BIS into cardiac anesthesia practice improves "fast-tracking," decreases anesthetic drug use, or detects cerebral ischemia. Recent research, including many cardiac surgical patients, shows that a protocol based on BIS monitoring is not superior to a protocol based on end-tidal anesthetic concentration monitoring in preventing awareness. There has been a resurgence of interest in the anesthesia literature in limited montage EEG monitoring, including nonproprietary processed indices. This has been accompanied by research showing that with structured training, anesthesiologists can glean useful information from the raw EEG trace. In this review, we discuss both the hypothesized benefits and limitations of BIS and frontal channel EEG monitoring in the cardiac surgical population. PDF   El impacto del BIS versus la concentración anestésica al final de la espiración sobre el tiempo de extubación traqueal en cirugía cardiaca ¨fast-track¨ The impact of bispectral index versus end-tidal anesthetic concentration-guided anesthesia on time to tracheal extubation in fast-track cardiac surgery. Villafranca A, Thomson IA, Grocott HP, Avidan MS, Kahn S, Jacobsohn E. Anesth Analg. 2013 Mar;116(3):541-8. doi: 10.1213/ANE.0b013e31827b117e. Epub 2013 Feb 11. Abstract BACKGROUND: Bispectral Index (BIS)-guided anesthesia administration has been reported to reduce the time to tracheal extubation. However, no trials have compared the ability of BIS guidance to promote earlier tracheal extubation relative to guidance by end-tidal anesthetic concentration (ETAC). We hypothesized that BIS-guided anesthesia would result in earlier tracheal extubation compared with ETAC-guided anesthesia in fast-track cardiac surgery patients. METHODS: This study consisted of patients at a single institution who were enrolled in the larger, multicenter BIS or Anesthesia Gas to Reduce Explicit Recall (BAG-RECALL) clinical trial that compared rates of postoperative awareness for patient whose anesthetic was guided by BIS versus ETAC. Patients undergoing cardiac surgery were randomized to BIS (n = 361) or ETAC (n = 362) guided anesthesia. Volatile anesthetic was titrated either to maintain a BIS value of 40 to 60 (BIS group), or an age-adjusted minimum alveolar concentration of 0.7 to 1.3 (ETAC group). In the ETAC group, anesthesiologists were blinded to the BIS values. In this substudy, time to tracheal extubation was compared between groups. Cox regression identified predictors affecting the instantaneous probability of tracheal extubation. RESULTS: Time to tracheal extubation was not significantly different between groups (odds ratio 1.04, 95% confidence interval, 0.88-1.23, P = 0.643). In addition, group assignment did not influence the instantaneous probability of tracheal extubation (P = 0.433). Predictors decreasing the instantaneous probability of tracheal extubation included higher body mass index (P = 0.001), higher logistic EuroSCORE (P = 0.015), complex surgery type (P = 0.034), and surgery completion in the evening (P = 0.03). CONCLUSIONS: Compared with management based on ETAC, anesthetic management based on BIS guidance does not strongly increase the probability of earlier tracheal extubation in patients undergoing fast-track cardiac surgery. The decision to extubate the trachea is more influenced by patient characteristics and perioperative course than the assignment to BIS or ETAC monitoring. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015