Bispectral index to guide induction of anesthesia: a randomized controlled study
Abstract Background It is unknown to what extent hypotension frequently observed following administration of propofol for induction of general anesthesia is caused by overdosing propofol. Unlike clinical signs, electroencephalon-based cerebral monitoring allows to detect and quantify an overdose of...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-06-01
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| Series: | BMC Anesthesiology |
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| Online Access: | http://link.springer.com/article/10.1186/s12871-018-0522-8 |
| _version_ | 1818148710085820416 |
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| author | Dirk Rüsch Christian Arndt Leopold Eberhart Scarlett Tappert Dennis Nageldick Hinnerk Wulf |
| author_facet | Dirk Rüsch Christian Arndt Leopold Eberhart Scarlett Tappert Dennis Nageldick Hinnerk Wulf |
| author_sort | Dirk Rüsch |
| collection | DOAJ |
| description | Abstract Background It is unknown to what extent hypotension frequently observed following administration of propofol for induction of general anesthesia is caused by overdosing propofol. Unlike clinical signs, electroencephalon-based cerebral monitoring allows to detect and quantify an overdose of hypnotics. Therefore, we tested whether the use of an electroencephalon-based cerebral monitoring will cause less hypotension following induction with propofol. Methods Subjects were randomly assigned to a bispectral index (BIS)-guided (target range 40–60) or to a weight-related (2 mg.kg− 1) manual administration of propofol for induction of general anesthesia. The primary endpoint was the incidence of hypotension following the administration of propofol. Secondary endpoints included the degree of hypotension and correlations between BIS and drop in mean arterial pressure (MAP). Incidences were analyzed with Fisher’s Exact-test. Results Of the 240 patients enrolled into this study, 235 predominantly non-geriatric (median 48 years, 25th – 75th percentile 35–61 years) patients without severe concomitant disease (88% American Society of Anesthesiology physical status 1–2) undergoing ear, nose and throat surgery, ophthalmic surgery, and dermatologic surgery were analyzed. Patients who were manually administered propofol guided by BIS (n = 120) compared to those who were given propofol by weight (n = 115) did not differ concerning the incidence of hypotension (44% vs. 45%; p = 0.87). Study groups were also similar regarding the maximal drop in MAP compared to baseline (33% vs. 30%) and the proportion of hypotensive events related to all measurements (17% vs. 19%). Final propofol induction doses in BIS group and NON-BIS group were similar (1.93 mg/kg vs. 2 mg/kg). There was no linear correlation between BIS and the drop in MAP at all times (r < 0.2 for all) except for a weak one at 6 min (r = 0.221). Conclusion Results of our study suggest that a BIS-guided compared to a weight-adjusted manual administration of propofol for induction of general anesthesia in non-geriatric patients will not lower the incidence and degree of arterial hypotension. Trial registration German Registry of Clinical Trials (DRKS00010544), retrospectively registered on August 4, 2016. |
| first_indexed | 2024-12-11T12:55:28Z |
| format | Article |
| id | doaj.art-012f2b25d85948fdb79af6e4633db789 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-11T12:55:28Z |
| publishDate | 2018-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-012f2b25d85948fdb79af6e4633db7892022-12-22T01:06:35ZengBMCBMC Anesthesiology1471-22532018-06-0118111010.1186/s12871-018-0522-8Bispectral index to guide induction of anesthesia: a randomized controlled studyDirk Rüsch0Christian Arndt1Leopold Eberhart2Scarlett Tappert3Dennis Nageldick4Hinnerk Wulf5Department of Anesthesia and Intensive Care, University Hospital Giessen-MarburgDepartment of Anesthesia and Intensive Care, University Hospital Giessen-MarburgDepartment of Anesthesia and Intensive Care, University Hospital Giessen-MarburgDepartment of Anesthesia and Intensive Care, University Hospital Giessen-MarburgDepartment of Anesthesia and Intensive Care, University Hospital Giessen-MarburgDepartment of Anesthesia and Intensive Care, University Hospital Giessen-MarburgAbstract Background It is unknown to what extent hypotension frequently observed following administration of propofol for induction of general anesthesia is caused by overdosing propofol. Unlike clinical signs, electroencephalon-based cerebral monitoring allows to detect and quantify an overdose of hypnotics. Therefore, we tested whether the use of an electroencephalon-based cerebral monitoring will cause less hypotension following induction with propofol. Methods Subjects were randomly assigned to a bispectral index (BIS)-guided (target range 40–60) or to a weight-related (2 mg.kg− 1) manual administration of propofol for induction of general anesthesia. The primary endpoint was the incidence of hypotension following the administration of propofol. Secondary endpoints included the degree of hypotension and correlations between BIS and drop in mean arterial pressure (MAP). Incidences were analyzed with Fisher’s Exact-test. Results Of the 240 patients enrolled into this study, 235 predominantly non-geriatric (median 48 years, 25th – 75th percentile 35–61 years) patients without severe concomitant disease (88% American Society of Anesthesiology physical status 1–2) undergoing ear, nose and throat surgery, ophthalmic surgery, and dermatologic surgery were analyzed. Patients who were manually administered propofol guided by BIS (n = 120) compared to those who were given propofol by weight (n = 115) did not differ concerning the incidence of hypotension (44% vs. 45%; p = 0.87). Study groups were also similar regarding the maximal drop in MAP compared to baseline (33% vs. 30%) and the proportion of hypotensive events related to all measurements (17% vs. 19%). Final propofol induction doses in BIS group and NON-BIS group were similar (1.93 mg/kg vs. 2 mg/kg). There was no linear correlation between BIS and the drop in MAP at all times (r < 0.2 for all) except for a weak one at 6 min (r = 0.221). Conclusion Results of our study suggest that a BIS-guided compared to a weight-adjusted manual administration of propofol for induction of general anesthesia in non-geriatric patients will not lower the incidence and degree of arterial hypotension. Trial registration German Registry of Clinical Trials (DRKS00010544), retrospectively registered on August 4, 2016.http://link.springer.com/article/10.1186/s12871-018-0522-8AnesthesiaInductionPropofolHemodynamicsHypotensionElectroencephalogram |
| spellingShingle | Dirk Rüsch Christian Arndt Leopold Eberhart Scarlett Tappert Dennis Nageldick Hinnerk Wulf Bispectral index to guide induction of anesthesia: a randomized controlled study BMC Anesthesiology Anesthesia Induction Propofol Hemodynamics Hypotension Electroencephalogram |
| title | Bispectral index to guide induction of anesthesia: a randomized controlled study |
| title_full | Bispectral index to guide induction of anesthesia: a randomized controlled study |
| title_fullStr | Bispectral index to guide induction of anesthesia: a randomized controlled study |
| title_full_unstemmed | Bispectral index to guide induction of anesthesia: a randomized controlled study |
| title_short | Bispectral index to guide induction of anesthesia: a randomized controlled study |
| title_sort | bispectral index to guide induction of anesthesia a randomized controlled study |
| topic | Anesthesia Induction Propofol Hemodynamics Hypotension Electroencephalogram |
| url | http://link.springer.com/article/10.1186/s12871-018-0522-8 |
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