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Anesth Analg 2006;103:1189-1195
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000244321.38023.92

TECHNOLOGY, COMPUTING, AND SIMULATION

Does Cerebral Monitoring Improve Ophthalmic Surgical Operating Conditions During Propofol-Induced Sedation?

Vivian L. B. Oei-Lim, MD, PhD*, Marcel G. W. Dijkgraaf, PhD{dagger}, Marc D. de Smet, MDCM, PhD{ddagger}, Martin White, MD, PhD*, and Cor J. Kalkman, MD, PhD§

From the Departments of *Anesthesiology, {dagger}Clinical Epidemiology & Biostatistics, {ddagger}Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam; and §Department of Anesthesiology, University Medical Center, University of Utrecht, Utrecht, Netherlands.

Sudden movements from over-sedation during ophthalmic surgery can be detrimental to the eye. Bispectral index (BIS) and middle-latency auditory-evoked potentials (Alaris AEP index, AAI) were reported to be accurate indicators for the level of sedation and loss of consciousness. We assessed these monitors during sedation with special emphasis on preventing over-sedation. One-hundred patients scheduled for elective eye surgery were sedated with target-controlled propofol infusion and randomly allocated to BIS-guided, AAI-guided, BIS/AAI-guided, or clinically guided groups (n = 25 each). The initial target concentration was 0.5 µg · mL–1 in patients >70 yr and 1.0 µg · mL–1 in all other patients. The concentration was increased every 3 min by 0.1 or 0.2 µg · mL–1, respectively until the patient had reached a BIS value of 75 (range 70–90) or an AAI of 40 (range 35–60). The surgeon who was blinded to group allocation assessed treatment quality after the procedure. Sedation was converted into general anesthesia in four patients because of excessive head movements. BIS was out of range 7% of the time vs 58% for AAI. No significant differences in treatment quality were observed among the four groups. We conclude that propofol sedation, guided by BIS or AAI monitoring, did not enhance ophthalmic surgical operating conditions over sedation guided by clinical observation only.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.