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LETTER TO THE EDITOR

Reduction in Requirement of Propofol During Combined Epidural (Bupivacaine) and General Anesthesia Guided by Bispectral Index

Department of Anaesthesiology; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Kerala, India; pksinha{at}sctimst.ac.in

To the Editor:

We have read with great interest the article by Agarwal et al. (1). However, we have several concerns regarding their study. First, authors have described cases that lasted for longer than 4 h although they have calculated doses of propofol up to 4 h only. Second, the authors used ephedrine for treatment of hypotension. We know that ephedrine influences the bispectral index value whereas phenylephrine does not (2). We would like to know why they chose ephedrine instead of phenylephrine. Further, it would be interesting to know the bispectral index values and the amount of propofol used after ephedrine injection. Third, the requirement of propofol for induction and maintenance was quite large as compared to the Gürses et al. (3) study, which did not use epidural and during which bispectral index was maintained at approximately 50, similarly to the present authors. We feel that their study would have been strengthened had they cited Gurses et al.’s (3) study in their reference list.

References

1. Agarwal A, Pandey R, Dhiraaj S, et al. The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium. Anesth Analg 2004;99:1684–8.[Abstract/Free Full Text]
2. Ishiyama T, Oguchi T, Iijima T, et al. Ephedrine, but not phenylephrine, increases bispectral index values during combined general and epidural anesthesia. Anesth Analg 2003;97:780–4.[Abstract/Free Full Text]
3. Gürses E, Sungurtekin H, Tomatir E, Dogan H. Assessing propofol induction of anesthesia dose using bispectral index analysis Anesth Analg 2004;98:128–31.[Abstract/Free Full Text]

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