Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-18T02:53:57.559Z Has data issue: false hasContentIssue false
  • English
  • Français

The effect of a remifentanil bolus on the bispectral index of the EEG (BIS) in anaesthetized patients independently from intubation and surgical stimuli

Published online by Cambridge University Press:  10 February 2006

D. A. Ferreira ,
C. S. Nunes ,
L. M. Antunes ,
I. A. Santos ,
F. Lobo ,
M. Casal ,
L. Ferreira  and
P. Amorim
D. A. Ferreira
Affiliation:
Universidade de Trás-os-Montes e Alto Douro, CECAV, Vila Real, Portugal
C. S. Nunes
Affiliation:
Universidade de Trás-os-Montes e Alto Douro, CECAV, Vila Real, Portugal Faculdade de Ciências da Universidade do Porto, Departamento de Matemática Aplicada, Porto, Portugal
L. M. Antunes
Affiliation:
Universidade de Trás-os-Montes e Alto Douro, CECAV, Vila Real, Portugal
I. A. Santos
Affiliation:
Hospital Geral de Santo António, Serviço de Anestesiologia, Porto, Portugal
F. Lobo
Affiliation:
Hospital Geral de Santo António, Serviço de Anestesiologia, Porto, Portugal
M. Casal
Affiliation:
Hospital Geral de Santo António, Serviço de Anestesiologia, Porto, Portugal
L. Ferreira
Affiliation:
Hospital Geral de Santo António, Serviço de Anestesiologia, Porto, Portugal
P. Amorim
Affiliation:
Hospital Geral de Santo António, Serviço de Anestesiologia, Porto, Portugal
Get access

Extract

Summary

Background and objective: Remifentanil boluses are used in different clinical situations and the effects on bispectral index monitoring are unclear. We analysed the effect of a remifentanil bolus on the bispectral index of the electroencephalogram (bispectral index) under total intravenous anaesthesia with propofol and remifentanil. Methods: ASA I–III patients were included in this study. All patients received a 2 μg k g−1 remifentanil bolus in a period free from stimuli. Bispectral index and haemodynamic data were collected from an A-2000XP bispectral index monitor (every second) and an AS/3 Datex monitor (every 5 s). Bispectral index data were analysed using the area under the curve. Mean arterial pressure and heart rate were averaged at each 30-s period and analysed using analysis of variance. Results: A total of 240 bispectral index values were obtained per patient. The area under the curve between 90 and 120 s after the bolus was significantly lower than the basal area under the curve (average of all areas before the bolus, P < 0.05). Mean arterial pressure and heart rate were significantly reduced from 96.4 ± 19.9 mmHg at the time of the bolus to 74.2 ± 16.6 mmHg 120 s after, and from 70 ± 16.4 bpm at the time of the bolus to 61 ± 13.6 bpm after (P < 0.001), respectively. Conclusions: There was a significant reduction in the areas under the curve between 90–120 s following the bolus. Heart rate and blood pressure also showed significant reductions. Thus, remifentanil bolus given under total intravenous anaesthesia with propofol and remifentanil decreases bispectral index, an effect independent of intubation and surgical stimuli.

Keywords

OPIOIDS, remifentanilANAESTHETICS INTRAVENOUS, propofolHAEMODYNAMIC PHENOMENA, heart rate, blood pressureANAESTHESIA, GENERAL, depth monitoringELECTROENCEPHALOGRAPHY, bispectral index
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 4 , April 2006 , pp. 305 - 310
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hall AP, Thompson JP, Leslie NA, Fox AJ, Kumar N, Rowbotham DJ. Comparison of different doses of remifentanil on the cardiovascular response to laryngoscopy and tracheal intubation. Br J Anaesth 2000; 84: 100–102.Google Scholar
O'Hare R, McAtamney D, Mirakhur RK, Hughes D, Carabine U. Bolus dose remifentanil for control of haemodynamic response to tracheal intubation during rapid sequence induction of anaesthesia. Br J Anaesth 1999; 82: 283–285.Google Scholar
Thompson JP, Hall AP, Russell J, Cagney B, Rowbotham DJ. Effect of remifentanil on the haemodynamic response to orotracheal intubation. Br J Anaesth 1998; 80: 467–469.Google Scholar
Alexander R, Olufolabi AJ, Booth J, El-Moalem HE, Glass PS. Dosing study of remifentanil and propofol for tracheal intubation without the use of muscle relaxants. Anaesthesia 1999; 54: 1037–1040.Google Scholar
Stevens JB, Wheatley L. Tracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants. Anesth Analg 1998; 86: 45–49.Google Scholar
Gesztesi Z, Mootz BL, White PF. The use of a remifentanil infusion for hemodynamic control during intracranial surgery. Anesth Analg 1999; 89: 1282–1287.Google Scholar
Egan TD, Kern SE, Muir KT, White J. Remifentanil by bolus injection: a safety, pharmacokinetic, pharmacodynamic, and age effect investigation in human volunteers. Br J Anaesth 2004; 92: 335–343.Google Scholar
Hans P, Bonhomme V, Born JD, Maertens de Noordhoudt A, Brichant JF, Dewandre PY. Target-controlled infusion of propofol and remifentanil combined with bispectral index monitoring for awake craniotomy. Anaesthesia 2000; 55: 255–259.Google Scholar
Sebel PS, Lang E, Rampil IJ et al. A multicentre study of bispectral electroencephalogram analysis for monitoring anesthetic effect. Anesth Analg 1997; 84: 891–899.Google Scholar
Glass PS, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836–847.Google Scholar
Struys M, Versichelen L, Mortier E et al. Comparison of spontaneous frontal EMG, EEG power spectrum and bispectral index to monitor propofol drug effect and emergence. Acta Anaesthesiol Scand 1998; 42: 628–636.Google Scholar
Guignard B, Menigaux C, Dupont X, Fletcher D, Chauvin M. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg 2000; 90: 161–167.Google Scholar
Finianos A, Hans P, Coussaert E, Brichant J, Dewandre P. Remifentanil does not affect the bispectral index or the relationship between propofol and the bispectral index at induction of anaesthesia. Br J Anaesth 1999; 82: A476.Google Scholar
Lysakowski C, Dumont L, Pellegrini M, Clergue F, Tassonyi E. Effects of fentanyl, alfentanil, remifentanil and sufentanil on loss of consciousness and bispectral index during propofol induction of anaesthesia. Br J Anaesth 2001; 86: 523–527.Google Scholar
Koitabashi T, Johansen JW, Sebel PS. Remifentanil dose/electroencephalogram bispectral response during combined propofol/regional anesthesia. Anesth Analg 2002; 94: 1530–1533.Google Scholar
Minto CF, Schnider TW, Egan TD et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology 1997; 86: 10–23.Google Scholar
Schnider TW, Minto CF, Shafer SL et al. The influence of age on propofol pharmacodynamics. Anesthesiology 1999; 90: 1502–1516.Google Scholar
Sebel PS, Bovill JG, Wauquier A, Rog P. Effects of high-dose fentanyl anesthesia on the electroencephalogram. Anesthesiology 1981; 55: 203–211.Google Scholar
Egan TD, Minto CF, Hermann DJ, Barr J, Muir KT, Shafer SL. Remifentanil vs. alfentanil: comparative pharmacokinetics and pharmacodynamics in healthy adult male volunteers. Anesthesiology 1996; 84: 821–833.Google Scholar
Billard V, Gambus PL, Chamoun N, Stanski DR, Shafer SL. A comparison of spectral edge, delta power, and bispectral index as EEG measures of alfentanil, propofol, and midazolam drug effect. Clin Pharmacol Ther 1997; 61: 45–58.Google Scholar
Strachan AN, Edwards ND. Randomized placebo-controlled trial to assess the effect of remifentanil and propofol on bispectral index and sedation. Br J Anaesth 2000; 84: 489–490.Google Scholar
Antunes LM, Roughan JV, Flecknell PA. Excitatory effects of fentanyl upon the rat electroencephalogram and auditory-evoked potential responses during anaesthesia. Eur J Anaesthesiol 2003; 20: 800–808.Google Scholar
Barr G, Anderson RE, Owall A, Jakobsson JG. Effects on the bispectral index during medium-high dose fentanyl induction with or without propofol supplement. Acta Anaesthesiol Scand 2000; 44: 807–811.Google Scholar
Mi WD, Sakai T, Singh H, Kudo T, Kudo M, Matsuki A. Hypnotic endpoints vs. the bispectral index, 95% spectral edge frequency and median frequency during propofol infusion with or without fentanyl. Eur J Anaesthesiol 1999; 16: 47–52.Google Scholar
Puri GD. Other stimuli add to effect of remifentanil on BIS. Anesth Analg 2003; 96: 632.Google Scholar
Muncaster AR, Sleigh JW, Williams M. Changes in consciousness, conceptual memory, and quantitative electroencephalographical measures during recovery from sevoflurane- and remifentanil-based anesthesia. Anesth Analg 2003; 96: 720–725.Google Scholar
Glass PS, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil. Anesth Analg 1999; 89: S7–S14.Google Scholar
Kazmaier S, Hanekop GG, Buhre W et al. Myocardial consequences of remifentanil in patients with coronary artery disease. Br J Anaesth 2000; 84: 578–583.Google Scholar
Starr NJ, Sethna DH, Estafanous FG. Bradycardia and asystole following the rapid administration of sufentanil with vecuronium. Anesthesiology 1986; 64: 521–523.Google Scholar