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Evaluation of BIS Monitorization Using Sevoflurane Versus Desflurane During Extracorporeal Circulation in Cardiovascular Surgery Anesthesia

Year 2018, Volume: 40 Issue: 3, 44 - 52, 01.09.2018
https://doi.org/10.20515/otd.405497

Abstract

The risk of awareness in cardiac surgery is 5 times higher
than in other surgeries. The use of cardiopulmonary bypass pump may lead to
inadequate anesthesia depth.
In this 
study we aimed to evaluate the awareness and the depth of anesthesia with BIS
monitorization in cardiovascular anesthesia. This study was designed as a
propective randomised controled trial. Sixty patients who underwent coronary
artery bypass grafting and heart valve surgery were included in the study. The patients were divided into 2 groups randomly. Maintenance of anesthesia provided by 2-4%
sevoflurane to Group 1 and 5-8% desflurane to Group 2 including extracorporeal
circulation period. Anesthesia depth adjusted according to hemodynamic and
clinical values. Patients in both groups were followed with BIS monitoring. In
all study groups, fixed dose of remifentanil infusion was initiated following
induction of anesthesia. Patients hemodynamic data, BIS measurements were
recorded during the operation. Considering the ease of recognitions and recall,
from the beginning of extracorporeal circulation, the dog barking was
constantly listened with earphones by patients to assess alertness and
awareness.  On the second postoperative
day, patients were asked whether they remember anything about operation and dog
barking. The obtained data were evaluated with SPSS package program. Similar hemodynamic data and BIS measurements were
obtained in both groups in our study. Postoperative awareness and remembrance
were not found in either group. In cardiovascular surgery, it was observed that
the depth of anesthesia determined by hemodynamic data is correlated with BIS,
but shifted to deeper levels of anesthesia. Although complications were not
seen in the patients, it was concluded that the adjusting the level of
anesthesia with BIS could be safer.
























References

  • 1. Ghoneim MM, Block RI,Haffarnan M, Mathews MJ. Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesth Analg, 2009. 108(2): 527-35
  • 2. Sebel PS, Bowdle TT, Ghoneim MM. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg, 2004. 99(3): 833-9
  • 3. Lopez U, Habre W, Van der Linden M. Intra-operative awareness in children and post-traumatic stress disorder. Anaesthesia, 2008. 63(5): 474-81
  • 4. Osterman JE, Hopper J, Heran WJ. Awareness under anesthesia and the development of posttraumatic stress disorder. Gen Hosp Psychiatry, 2001. 23(4): 198-204
  • 5. Lennmarken C, Bildfors K, Enlund G, Samuelsson P. Victims of awareness. Acta Anaesthesiol Scand, 2002. 46(3): 229-31
  • 6. Leon Serfontein. Awareness in cardiac anesthesia. Current Opinion in Anaesthesiology 2010. 23(1):103-108
  • 7. Savlı S, Adalığ B, Özalp G. Bispektral İndeks monitörizasyonunun sevofluran tüketimi ve derlenme üzerine etkisi. Anestezi Dergisi, 2005; 13 (2): 96-100
  • 8. Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev, 2007(4): 38-43
  • 9. Aretha D, Kiekkas P, Eleftheria P. Anesthesia awareness and the bispectral index. N Engl J Med, 2008. 359(4): 429-30; author reply 430-1
  • 10. Odri A, Cavalcanti A, Billard V, [Falsely elevated-bispectral index]. Ann Fr Anesth Reanim, 2008. 27(11): 945-8
  • 11. Sebel PS, Bowdle A, Ghoneim MM, Rampil IJ, Padilla RE. The incidence of awareness during anesthesia: a multicenter U.S. study. Anesthesiology 2003;99:A360 Pinsker M.C. Anesthesia: a pragmatic construct. Anesthesia and Analgesia 1986;65:819-820
  • 12. Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during general anesthesia: a prospective case study. Lancet 2000;355:707-711
  • 13. Domino KB, Posner KL, Çaplan RA, Cheney FW. Awareness during Anesthesia: AClosed Claims Analysis. Anesthesiology 1999;90:1053-1061
  • 14. Song D, Joshi GP, White PF. Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory ansthesia. Anesthesiology 1997;87:842-848
  • 15. While PF, Hong M, Tang J, Wender RH, Sioninsky A, Kariger R. Does the use of electroensefalographic bispcctral index or auditory evoked potential index monitoring facilitate recovery after desflurane anesthesia in the ambulatory setting? Anesthesiology 2004:100:811-817
  • 16. O'Connor MF, Daves SM, Tung A. BIS monitoring to prevent awareness during general anesthesia. Anesthesiology 2001;94:520-522
  • 17. Schwender D, Faber-Zullig E, Klasing S, Poppel E, Peter K. Motor signs of wakefulness during general anesthesia with propofol. isoflurane and flunitrazepam/fentanyl and midlatency auditory evoked potentials. Anesthesia 1994;49:476-484
  • 18. Dowd NP, Cheng DCH, Karski JM Wong DT, Munro Jo AC, Sandler AN. Intraoperative awareness in fast track cardiac anesthesia. Anesthesiology 1998;89:1068-1073
  • 19. Puri GD. Paradoxical changes in bispectral index during nitrous oxide administration. Br J Anaesth 2001;86:141–2
  • 20. Leslie K, Myles PS, Forbes A, Chan MT. The effect of bispectral index monitoring on long-term survival in the B-aware trial. Anesth Analg. 2010; 110:816–22
  • 21. Nitzschke R, Wilgusch J, Kersten JF. Bispectral index guided titration of sevoflurane in on-pump cardiac surgery reduces plasma sevoflurane concentration and vasopressor requirements. Eur J Anaesthesiol 2014; 31:482–490

Kardiovasküler Cerrahi Anestezisinde Ekstrakorporeal Dolaşımda Sevofluran ve Desfluran Kullanımının BIS Monitorizasyonu ile Değerlendirilmesi

Year 2018, Volume: 40 Issue: 3, 44 - 52, 01.09.2018
https://doi.org/10.20515/otd.405497

Abstract

Kardiyovasküler cerrahide anestezi sırasında
farkındalık diğer cerrahilere göre 5 kat fazladır. Kalp akciğer pompası
kullanımı yetersiz anestezi derinliğine sebep olabilir. Çalışmamaızda
sevofloran ve desfloran ile uygulanan kardiak anestezide BİS eşliğinde
farkındalık ve anestezi derinliğini belirlemeyi amaçladık. Prospektif ve
randomize olarak tasarladığımız çalışmamız koroner arter ve kalp kapak
cerrahisi geçirecek 60 kişi dahil edildi. Rastgele 2 gruba ayrılan hastalara
sevofloran ve desfloran ile inhalasyon anestezisi ile analjezi için sabit doz
remifentanil infuzyonu uygulandı. Hemodinamik veriler ve BİS değerleri
kaydedildi. Kolay hatırlanabilmesi nedeniyle tanıdık ses olan köpek havlaması
ekstrakorporeal dolaşım boyunca hastalara dinletildi. Post operatif 2. günde
farkındalık ve uyanıklık için hastalarla görüşme yapıldı ve kaydedildi. Elde
edilen veriler SPSS ile incelendi. Hastalarda benzer hemodinamik veriler ve BİS
değerleri olduğu görüldü. Hastalarda farkındalık ve uyanıklığa rastlanılmadı.Kardiyovasküler
anestezi uygulamasında anestezi derinliğinin hemodinamik veriler ile
belirlenmesinin BİS ile korele olmasına rağmen anestezinin daha derin
seviyeye  doğru kaydığı görüldü. Bu nedenle BİS ile anestezi derinliğinin
güvenli şekilde belirlenebileceği kanısına varıldı. 

References

  • 1. Ghoneim MM, Block RI,Haffarnan M, Mathews MJ. Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesth Analg, 2009. 108(2): 527-35
  • 2. Sebel PS, Bowdle TT, Ghoneim MM. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg, 2004. 99(3): 833-9
  • 3. Lopez U, Habre W, Van der Linden M. Intra-operative awareness in children and post-traumatic stress disorder. Anaesthesia, 2008. 63(5): 474-81
  • 4. Osterman JE, Hopper J, Heran WJ. Awareness under anesthesia and the development of posttraumatic stress disorder. Gen Hosp Psychiatry, 2001. 23(4): 198-204
  • 5. Lennmarken C, Bildfors K, Enlund G, Samuelsson P. Victims of awareness. Acta Anaesthesiol Scand, 2002. 46(3): 229-31
  • 6. Leon Serfontein. Awareness in cardiac anesthesia. Current Opinion in Anaesthesiology 2010. 23(1):103-108
  • 7. Savlı S, Adalığ B, Özalp G. Bispektral İndeks monitörizasyonunun sevofluran tüketimi ve derlenme üzerine etkisi. Anestezi Dergisi, 2005; 13 (2): 96-100
  • 8. Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev, 2007(4): 38-43
  • 9. Aretha D, Kiekkas P, Eleftheria P. Anesthesia awareness and the bispectral index. N Engl J Med, 2008. 359(4): 429-30; author reply 430-1
  • 10. Odri A, Cavalcanti A, Billard V, [Falsely elevated-bispectral index]. Ann Fr Anesth Reanim, 2008. 27(11): 945-8
  • 11. Sebel PS, Bowdle A, Ghoneim MM, Rampil IJ, Padilla RE. The incidence of awareness during anesthesia: a multicenter U.S. study. Anesthesiology 2003;99:A360 Pinsker M.C. Anesthesia: a pragmatic construct. Anesthesia and Analgesia 1986;65:819-820
  • 12. Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during general anesthesia: a prospective case study. Lancet 2000;355:707-711
  • 13. Domino KB, Posner KL, Çaplan RA, Cheney FW. Awareness during Anesthesia: AClosed Claims Analysis. Anesthesiology 1999;90:1053-1061
  • 14. Song D, Joshi GP, White PF. Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory ansthesia. Anesthesiology 1997;87:842-848
  • 15. While PF, Hong M, Tang J, Wender RH, Sioninsky A, Kariger R. Does the use of electroensefalographic bispcctral index or auditory evoked potential index monitoring facilitate recovery after desflurane anesthesia in the ambulatory setting? Anesthesiology 2004:100:811-817
  • 16. O'Connor MF, Daves SM, Tung A. BIS monitoring to prevent awareness during general anesthesia. Anesthesiology 2001;94:520-522
  • 17. Schwender D, Faber-Zullig E, Klasing S, Poppel E, Peter K. Motor signs of wakefulness during general anesthesia with propofol. isoflurane and flunitrazepam/fentanyl and midlatency auditory evoked potentials. Anesthesia 1994;49:476-484
  • 18. Dowd NP, Cheng DCH, Karski JM Wong DT, Munro Jo AC, Sandler AN. Intraoperative awareness in fast track cardiac anesthesia. Anesthesiology 1998;89:1068-1073
  • 19. Puri GD. Paradoxical changes in bispectral index during nitrous oxide administration. Br J Anaesth 2001;86:141–2
  • 20. Leslie K, Myles PS, Forbes A, Chan MT. The effect of bispectral index monitoring on long-term survival in the B-aware trial. Anesth Analg. 2010; 110:816–22
  • 21. Nitzschke R, Wilgusch J, Kersten JF. Bispectral index guided titration of sevoflurane in on-pump cardiac surgery reduces plasma sevoflurane concentration and vasopressor requirements. Eur J Anaesthesiol 2014; 31:482–490
There are 21 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section ORİJİNAL MAKALE
Authors

Ebru Karakoç This is me

İlkay Ceylan

Belkıs Tanrıverdi This is me

Publication Date September 1, 2018
Published in Issue Year 2018 Volume: 40 Issue: 3

Cite

Vancouver Karakoç E, Ceylan İ, Tanrıverdi B. Evaluation of BIS Monitorization Using Sevoflurane Versus Desflurane During Extracorporeal Circulation in Cardiovascular Surgery Anesthesia. Osmangazi Tıp Dergisi. 2018;40(3):44-52.


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