The Feasibility of Bispectral Index Monitoring: METHODS

In: Anesthesia

16 Sep 2009

We randomly recruited 14 patients of American Society of Anesthesiologists’ classification I and II about to undergo oral surgery or dental treatment requiring less than 5 hours under general anesthesia (GA group, n = 7) or intravenous sedation (IVS group, n = 7) at the Nihon University School of Dentistry Hospital in Japan. Approval was granted by local institutional ethics committee, and written informed consent was obtained from all participants.

Premedication in the GA group consisted of admin-ISSN istration of 1-2 mg (oral administration) of lormetaze-pam (1,4-benzodiazepine) before sleeping and 0.5 mg of *Generic Atropisol sulfate and 50-75 mg (intramuscular injection) of hydroxyzine hydrochloride 30 minutes before surgery. After entering the operating theatre, the sensor of the bispectral index monitor (A-1050 version 3.4 1999, Aspect Medical Systems, Newton, Mass) was attached to the forehead of each patient and baseline readings before surgery (bispectral index, SQI, EMG, and impedance) recorded. For induction of anesthesia, patients received 2 |xgkg_1 of fentanyl citrate and 2 mg-kg-1 (intravenous injection) of propofol infusion, and after losing consciousness 10 mg-kg_1h_1 of propofol continuous infusion was started. They then received 0.15 mg-kg-1 (intravenous injection) of vecuronium bromide and had their tracheas intubated.

During surgery, nitrous oxide, oxygen, and propofol were used to maintain the desired level of anesthesia (fraction of inspired oxygen = 0.35), with fentanyl citrate and vecuronium bromide used as appropriate. A local anesthetic consisting of a mixture of 2% lidocaine, 1:80,000 epinephrine, and 0.5% bupivacaine was injected into the surgical region in all patients.

In the IVS group, the bispectral index monitor sensor was attached to the forehead and baseline readings recorded for each patient as for the GA group. Oxygen was then given from a nasal canula followed by a sedative dose of propofol (2 тд-кд_1_1), nitrous oxide, and oxygen. During surgery, nitrous oxide, oxygen, and propofol (0-6 mgkg-^h-1) were used to maintain the level of sedation. A local anesthetic consisting of a mixture of 2% lidocaine, 1: 80,000 epinephrine, and 0.5% bupivacaine was injected into the surgical region in all patients. buy generic levitra

We recorded the SQI, EMG, and impedance every 5 seconds onto a personal computer using a hypertermin­al. Using these data, the number of “good” EEGs was determined by calculating the ratio of EEG epochs that satisfied Johansen and Koitabashi’s criteria (EMG input, >50 dB; SQI, >25%; impedance, > 10,000 ft 10 kft) and compared between the GA and IVS groups. All data represent the mean ± SD. Data were statistically analyzed using Student’s t test and the x2 test. Statistical significance was established at the P < .05 level.


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