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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 Anaesthesia; Sanjay Gandhi Post Graduate Institute of Medical Sciences; Lucknow, India; aagarwal{at}sgpgi.ac.in

In Response:

We would like to thank Sinha et al. for their interest in our article and their valuable comments. Their first concern is that we have enrolled cases that lasted more than 4 h, although we have calculated doses of propofol up to 4 hr only. We calculated propofol requirement on an hourly basis for only the first 4 h of surgery because we felt that propofol requirements might vary with the change in duration of surgery; in addition, this maintained uniformity in data collection. We are in agreement with Sinha et al. that phenylephrine is a better choice than ephedrine in the treatment of hypotension (1). Their other concern regarding increased requirement of propofol for induction and maintenance in our study as compared with that of Gürses et al. is not valid (2,3). First, we would like to clarify that Gürses et al. did not study the requirement of propofol during maintenance of anesthesia (3). Furthermore, Gürses et al. only observed the propofol requirement in mg (mean ± sd) and weight of patients enrolled in their study was mentioned separately (mean ± sd). In our study, we mentioned propofol required in mg/kg (2). These two values are not comparable, as propofol requirement in mg (mean ± sd) divided by weight of patients in kg (mean ± sd) will not be the same as mg/kg (mean ± sd).

References

1. 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]
2. Agarwal A, Pandey R, Dhiraaj S et al. 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]
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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