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LETTER TO THE EDITOR

Bispectral Index Does Not Correlate with the Stress Response in Critical Care Patients

Department of Pharmacy; Clinical and Administrative Sciences; College of Pharmacy-Tulsa; University of Oklahoma; Tulsa, OK (LeBlanc) Center for Pharmacoinformatics and Outcomes Research; School of Pharmacy; University of Pittsburgh; Pittsburgh, PA (Kane-Gill) General Surgery and Surgical Critical Care; The Ohio State University and The Ohio State University Medical Center; Columbus, OH (Cook) Division of Pharmacy Practice and Administration; College of Pharmacy; The Ohio State University; Columbus, OH; dasta{at}pharmacy.ohio-state.edu (Dasta)

To the Editor:

In a recent article, Park et al. (1) reported a lack of correlation between the bispectral index (BIS) and the Observer Assessment of Alertness and Sedation score in patients receiving epidural anesthesia and nitrous oxide sedation. Despite changes in Observer Assessment of Alertness and Sedation score during nitrous oxide administration, BIS did not change.

We evaluated the utility of BIS in neuromuscular-blocked, intensive care unit (ICU) patients by comparing it to a measure of the stress response, PRST scale (blood pressure, heart rate, sweat, and tear formation), since there are few data in the ICU (2,3). Fifteen sedated and paralyzed patients in the surgical ICU had simultaneous PRST and BIS scores recorded during their ICU stay for a total of 40 recordings. Average age (years) and APACHE II score were 52.0 ± 15.6 and 29.3 ± 6.6, respectively. There was a poor correlation between PRST and BIS (r_s² = 0.029, P = 0.654). In patients with a low stress response, i.e., PRST score 0, the BIS ranged from 0 to 58. We conclude that BIS does not correlate with the physiologic stress responses from the PRST score in paralyzed, sedated ICU patients. Their respective roles need to be further clarified before they are routinely used in critical care.

REFERENCES

1. Park KS, Hur JE, Woo K, et al. Bispectral index does not correlate with observer assessment of sedation scores during 0.5% bupivicane epidural anesthesia with nitrous oxide sedation. Anesth Analg 2006;103:385–9.[Abstract/Free Full Text]
2. Evans J, Davies W. Monitoring anaesthesia. Clin Anaesthesiol 1984;2:243–62.
3. LeBlanc J, Dasta JF, Kane-Gill S. The role of bispectral index in sedation monitoring in the ICU. Ann Pharmacother 2006;40: 490–500.[Abstract/Free Full Text]

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