This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (13) Citing Articles via Google Scholar Google Scholar Articles by Morimoto, Y. Articles by Hagihira, S. Search for Related Content PubMed PubMed Citation Articles by Morimoto, Y. Articles by Hagihira, S. Related Collections Cardiovascular Neuroanesthesia Monitoring (Non-cardiac)

---

TECHNOLOGY, COMPUTING, AND SIMULATION

The Detection of Cerebral Hypoperfusion with Bispectral Index Monitoring During General Anesthesia

Yasuhiro Morimoto, MD^*, Yoko Monden, MD^*, Kazunobu Ohtake, MD^*, Takefumi Sakabe, MD^*, and Satoshi Hagihira, MD

*Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine, Yamaguchi, Japan; and Department of Anesthesiology, Osaka University Graduate School of Medicine, Osaka, Japan

Address correspondence and reprints request to Yasuhiro Morimoto, MD, Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi Ube, Yamaguchi, 755-8505, Japan. Address e-mail to yamorimo{at}nifty.com

We describe a patient in whom the bispectral index (BIS) decreased to 0 during surgery. A 42-yr-old man with chronic renal failure was scheduled to undergo construction of an arteriovenous shunt. He had a history of acute cerebral hemorrhage. An intracranial hematoma had been removed a month earlier with almost complete neurological recovery. He had uncontrolled hypertension. His systolic blood pressure was 180 mm Hg before anesthesia induction. Anesthesia was induced with 100 mg of propofol and 3% sevoflurane. After laryngeal mask insertion, anesthesia was maintained with nitrous oxide 60% in oxygen and sevoflurane. BIS decreased to near 0 on 2 occasions: after anesthesia induction and shortly after the start of the surgery. His systolic blood pressure decreased to 110 mm Hg and BIS increased when his blood pressure was increased to 130–140 mm Hg. The decrease in BIS was suspected to be the result of decreased cerebral blood flow. The systolic blood pressure of 110 mm Hg (mean blood pressure, 80 mm Hg) was probably less than the lower limit of autoregulation. Although BIS has some limitations as a cerebral monitor, it was useful for detecting possible cerebral hypoperfusion in this case.

IMPLICATIONS: We describe a patient in whom bispectral index decreased to 0 during general anesthesia, possibly because of cerebral hypoperfusion.

This article has been cited by other articles:

				H. Yoshida, T. Kushikata, S. Kabara, H. Takase, H. Ishihara, and K. Hirota Flat Electroencephalogram Caused by Carbon Dioxide Pneumoperitoneum Anesth. Analg., December 1, 2007; 105(6): 1749 - 1752. [Abstract] [Full Text] [PDF]

				D. Duncan, K. P. Kelly, and P. J. D. Andrews A comparison of bispectral index and entropy monitoring, in patients undergoing embolization of cerebral artery aneurysms after subarachnoid haemorrhage Br. J. Anaesth., May 1, 2006; 96(5): 590 - 596. [Abstract] [Full Text] [PDF]

				A. Deogaonkar, R. Vivar, R. E. Bullock, K. Price, I. Chambers, and A. D. Mendelow Bispectral index monitoring may not reliably indicate cerebral ischaemia during awake carotid endarterectomy Br. J. Anaesth., June 1, 2005; 94(6): 800 - 804. [Abstract] [Full Text] [PDF]

				Y. Morimoto, A. Matsumoto, Y. Koizumi, T. Gohara, T. Sakabe, and S. Hagihira Changes in the Bispectral Index During Intraabdominal Irrigation in Patients Anesthetized with Nitrous Oxide and Sevoflurane Anesth. Analg., May 1, 2005; 100(5): 1370 - 1374. [Abstract] [Full Text] [PDF]