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TECHNOLOGY, COMPUTING, AND SIMULATION

Bispectral Index in Patients with Target-Controlled or Manually-Controlled Infusion of Propofol

Andreas Lehmann, MD^*, Joachim Boldt, MD^*, Elfi Thaler, MD^*, Swen Piper, MD^*, and Udo Weisse, MD

Departments of *Anesthesiology and Intensive Care Medicine and Cardiac Surgery, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany

Address correspondence and reprint requests to Andreas Lehmann, MD, Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Postfach 21 73 52, D-67073 Ludwigshafen, Germany. Address e-mail to Dr.A.Lehmann{at}web.de

In this prospective, randomized study we compared bispectral index (BIS), hemodynamics, time to extubation, and the costs of target-controlled infusion (TCI) and manually-controlled infusion (MCI) of propofol. Forty patients undergoing first-time implantation of a cardioverter-defibrillator were included. Anesthesia was performed with remifentanil (0.2–0.3 µg · kg^-1 · min^-1) and propofol. Propofol was used as TCI (plasma target concentration, 2.5–3.5 µg/mL; n = 20) or MCI (3.0–4.0 mg · kg^-1 · h^-1; n = 20). BIS, heart rate, and arterial blood pressure were measured at six data points: T1, before anesthesia; T2, after intubation; T3, after skin incision; T4, after first defibrillation; T5, after third defibrillation; and T6, after extubation. There were no significant hemodynamic differences between the two groups. BIS was significantly lower at T3 and T4 in the TCI group than in the MCI group. The mean dose of propofol was larger in TCI patients (5.8 ± 1.4 mg · kg^-1 · h^-1) than in the MCI patients (3.7 ± 0.6 mg · kg^-1 · h^-1) (P < 0.05), whereas doses of remifentanil did not differ. Time to extubation did not differ between the two groups (TCI, 13.7 ± 5.3 min; MCI, 12.3 ± 3.5 min). One patient in the MCI group had signs of intraoperative awareness without explicit memory after first defibrillation (BIS before shock, 49; after shock, 83). Costs were significantly less in the MCI group (US$34.83) than in the TCI group (US$39.73). BIS failed to predict the adequacy of anesthesia for the next painful stimulus.

IMPLICATIONS: In this prospective, randomized study, bispectral index (BIS), hemodynamics, time to extubation, and costs of target-controlled infusion (TCI) and manually-controlled infusion of propofol were compared. TCI increased the amount of propofol used. BIS failed to predict the adequacy of anesthesia for the next painful stimulus.

This article has been cited by other articles:

				K. M. Scheufler, P. C. Reinacher, W. Blumrich, J. Zentner, and H.-J. Priebe The Modifying Effects of Stimulation Pattern and Propofol Plasma Concentration on Motor-Evoked Potentials Anesth. Analg., February 1, 2005; 100(2): 440 - 447. [Abstract] [Full Text] [PDF]

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