Buradasınız

Anasayfa » Content

Pediyatrik Olgularda Bispektral İndeks Monitorizasyonun Hemodinami, Derlenme ve Kullanım Maliyeti Üzerine Etkileri

The Effect of Bispectral Index Monitoring on Hemodynamic Change, Recovery and Anesthetic Cost in Children Anesthetized

Journal Name:

  • Uludağ Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2008

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
In this study we aimed to investigate the effects of Bispectral index score (BIS) on the hemodynamic changes, recovery time and cost effectivenes in pediatric patients who received general anesthesia combined with caudal epidural block. The patients were randomized into two groups; the Group I received anesthetic drugs according to BIS monitoring, the Group II to hemodynamic changes. In the both groups, anesthesia was induced with propofol 3 mg kg -1 , fentanyl 2 µg kg -1 and mivacurium 0.2 mg kg -1 and maintained with %40 O2, %60 N2O and desflurane. In the Group I, the volatile anesthetic was titrated to maintain BIS index between 40-60. In the Group II, the titration was made according to patients hemodynamic changes and BIS values were recorded by blinded anesthesiologist. There was no statistical differences in demographic data and measured parametres in the both groups. Also no differences were found between the time from cessation of anesthetics to extubation and the time leaving the recovery room between the groups. The amount of anesthetic agent was less in BIS group then the Group II. The cost effect were found higher in the Group I than Group II. Although there were no difference between groups in terms of hemodynamic and recovery times. The amount of agent less in the BIS group. It was concluded that in pediatric patients BIS monitoring has no advantage over standart practice in short procedures under both caudal epidural block and general anesthesia.
Bookmark/Search this post with
Abstract (Original Language): 
Kaudal epidural bloğun genel anestezi ile birlikte uygulandığı pediyatrik olgularda, Bispektral İndeks Skor (BİS) kullanımının hemodinamik değişiklikler, derlenme zamanı ve kullanım maliyeti üzerine olan etkilerini incelemeyi amaçladık. Olgular rasgele iki gruba ayrıldılar. Grup I (n=26) olgulara BİS monitorizasyonuna göre, Grup II (n=26) olgulara hemodinamik yanıtlarına göre genel anestezi uygulandı. Her iki gruba indüksiyonda 3 mg kg -1 propofol, 2 µg kg -1 fentanil ve 0.2 mg kg -1 mivakuryum iv uygulandı. Endotrakeal entübasyondan sonra anestezi idamesi sabit akımla %40 oksijen (2 L dk -1 ), %60 N2O (4 L dk -1 ) ve desfluran ile sağlandı. Grup I’de FiDes , BİS değeri 40-60 arasında olacak şekilde titre edildi. Grup II’de ise FiDes hemodinamik yanıtlara göre titre edildi. Grup II’de BİS kayıtları uygulayıcı anestezisten habersiz bir başka anestezist tarafından kaydedildi. Anestezi süresince kullanılan ilaçların miktarları hesaplanarak, maliyetleri kaydedildi. Her iki grubun demografik verileri arasında istatistiksel farklılık saptanmadı. Entübasyondan sonra ölçülen tüm değişkenlerde gruplar arasında farklılık görülmedi. Anestezikler sonlandırılıp ekstübasyona kadar geçen süre ve derlenme odasındaki derlenme süreleri arasında farklılık bulunmadı. Buna karşın BİS ile anestezik titrasyonu yapılan grupta ilaç tüketimi daha düşüktü. Grup I’de anestezi maliyeti Grup II’den yüksek bulundu. BİS monitorizasyonu uygulanan olgularla uygulanmayanlar arasında hemodinami, derlenme zamanı arasında fark saptanmazken, BİS monitorizasyonu uygulanan olgularda kullanılan ilaç miktarının azaldığı, fakat BİS sensörlerinin maliyeti arttırdığı bulunmuştur. Bu nedenle pediyatrik olgularda kısa süreli cerrahi girişimlerde kaudal blok ve genel anestezi varlığında BİS monitorizasyonunun fayda sağlamayacağı sonucuna varıldı
FULL TEXT (PDF): 
PDF icon arastirmax-pediyatrik-olgularda-bispektral-indeks-monitorizasyonun-hemodinami-derlenme-kullanim-maliyeti-uzerine-etkileri.pdf
  • 3
115-121
  • Turkish

REFERENCES

References: 

1. Stanski DR: Monitoring depth of anesthesia. In:Miller RD (eds),
Anesthesia. New York: Churchill Livingstone Inc; 2000;1087-
116.
2. Kissin I:General anesthetic action:An obsolete notion? Anesth
Analg 1993;76: 215-7.
3. Tomas DW, Runciman WB: Monitoring depth of anaesthesia.
Anaesth Intensive Care 1988;16:69-70.
4. Pinsker MC: Anaesthesia; a pragmatic construct (letter) Anesth
Analg 1986;65:819-20.
5. Kayhan Z. Klinik Anestezi: İstanbul:Logos Yayıncılık 1997.56-
60.
6. Kearse LA, Rosow C, Zaslavsky A, et al. Bispectral analysis of
the electroencephalogram predicts conscious processing of information during propofol sedation and hypnosis. Anesthesiology 1998;88:25–34.
7. Rosow C, Manberg PJ. Bispectral index monitoring. Anesth
Clin North Am 1998;2: 89–107.
8. Glass, PSA, Sebel PS, Rosow C, et al. Improved propofol
titration using the Bispectral Index (BIS). Anesthesiology
1996;85:351-5.
9. Sebel, PS, Payne F, Gan T, et al. Bispektral analysis (BIS)
monitoring improves PACU recovery from propofol alfentanil/N2O Anesthesia. Anesthesiology 1996;85: 1056-7.
10. Payne F,Sebel PS, Glass PSA, et al. Bispectral indeks (BIS)
monitoring allows faster emergence from propofol alfentanil/N2O Anesthesia. Anesthesiology 1996;85:1056-61.
11. Dexter F, Macario A, Manberg PJ, et al. Computer simulation
to determine how rapid anesthetic recovery protocols to decrease the time for emergence or increase the phase I postanesthesia care unit bypass rate affect staffing of an ambulatory surgery center. Anesth Analg 1999;88:1053-63. Pediyatrik Olgularda Bispektral İndeks
121
12. Yli-Hankala A, Vakkuri A, Annila P, et al. EEG bispectral
index monitoring in sevoflurane or propofol anaesthesia: analysis of direct costs and immediate recovery. Acta Anaesthesiol
Scand 1999; 43:545-9.
13. Aldrette JA, Kroulik D.A postanesthetic recovery score. Anesth
Analg 1970;51:543-6.
14. Dion P:The cost of anesthetic vapours. Can J Anesth 1992;39:
633.
15. Doi M, Gajraj RJ, Mantzaridis H, et al. Relationship between
calculated blood concentration of propofol and electrophysiological variables during emergence from anaesthesia: comparison of bispectral index, spectral edge frequency, median frequency and auditory evoked potential index. Br J Anaesth
1997;78:180-4.
16. Liu J, Singh H, White PF. Electroencephalographic bispectral
index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg 1997;84: 185-9.
17. Billard V, Moulla F, Bourgain JL, et al. Hemodynamic response to induction and intubation. Propofol/fentanyl interaction. Anesthesiology 1994;81:1384-93.
18. Kearse LA Jr, Manberg P, Debros F, et al. Bispectral analysis
of the electroencephalogram during induction of anesthesia
may predict hemodynamic responses to laryngoscopy and intubation. Electroenceph Clin Neurophysiol 1994; 90:194-200.
19. Wei- Dong M, Sakai T, Takahashi S, et al. Haemodynamic and
electraencephalograph responses to intubation during induction
with propofol or propofol/ fentanyl. Can J Anesth 1998;45:19-
22.
20. Kazama T, Ikeda K, Morita K. The pharmacodynamic interaction between propofol and fentanyl with respect to the supression of somatic or hemodynamic responses to skin incision,
peritoneum incision, abdominal wall retraction. Anesthesiology
1998; 89:894-906.
21. Nakayama M, Hiromichi I, Yamamoto S, et al. The effect of
fentanyl on hemodynamic and Bispectral Index changes during
anaesthesia induction with propofol. J. Clin Anaesth
2002;14:146-9.
22. Lui PW, Wang H, Kearse LA. The bispectral index does not
predict hemodynamic responses to laryngoscopy and intubation
during propofol- inducted EEG burst supression. Anesthesiology 1996;85:175-6.
23. Billard V, Moulla F, Bourgain JL, et al. Hemodynamic response to induction and intubation. Propofol/ fentanyl interaction. Anesthesiology 1994;81:185-9.
24. Dressien JJ, Harbers JBM, Egmond van J, et al. Evaluation of
the electrocephalographic bispectral index during fentanyl- midazolam anaesthesia for cardiac surgery. Does it predict
haemodynamic responses during endotracheal intubation and
sternotomy? Eur J Anaesthesiol 1999; 16:622-7.
25. Slavov V, Motamed C, Massou N, et al. Systolic blood pressure,
not BIS, is associated with movement during laryngoscopy and
intubation. Can J Anesth 2002;49:918-21.
26. Tadahiko I, Takeshi O,Tetsuya I, et al. Ephedrine, but not
phenylephrine, increases Bispectral Index values during combined general and epidural anesthesia. Anesth Analg
2003;97:780–4.
27. Moerman N, Bonke B, Oosting J. Awarensess and recall during
general anesthesia. Anesthesiology 1993;79:454-64.
28. Sebel PS, Lang E, Rampil IJ, et al. A multicenter study of
bispectral electroencephalogram analysis for monitoring anesthetic effect. Anesth Analg 1997; 84:891-9.
29. Kandel l, Chortkoff BS, Sonner J, et al. Non anesthetics can
suppres learning. Anesth Analg1996;82:321-6.
30. Kumar N, Mirakur K, Symington MJ, et al. A comparison of
the effects of isoflurane and desflurane on the neuromuscular
effects of mivacurium. Anaesthesia 1996;51:547-50.
31. Rampil IJ, Mason P, Singh H: Anesthetic potency (MAC) is
independent of forebrain structures in the rat. Anesthesiolgy
1993;78:707-12.
32. Rampil IJ: Anesthetic potency (MAC) is not altered after
hypnotic spinal cord transection in rats. Anesthesiology
1994;80:606-10.
33. Eappen S, Kissin I. Effect of subarachnoid bupivacaine block
on anesthetic requirements for thiopental in rats. Anesthesiology 1998;88:1036-42.
34. Davidson AJ, Ironfield CM, Skinner AD,et al. The effects of
caudal local anesthesia blockade on the Bispectral Index during
general anesthesia in children. Pediatric Anesthesia
2006;16:828–33.
35. Antognini JF, Jinks SL, Atherley R, et al. Spinal anaesthesia
indirectly depresses cortical activity associated with electrical
stimulation of the reticular formation. Br J Anaesth
2003;91:233–8.
36. Rampil IJ. A Primer for EEG signal processing in anesthesia.
Anesthesiology 1998; 89: 980-1002.
37. Tverskoy M, Fleysman G, Bachrak L, et al. Effect of bupivacaine induced spinal block on the hypnotic requirement of propofol. Anaesthesia 1996;51:652-3.
38. Tverskoy M, Shifrin V, Finger J. Effect of epidural bupivacaine
block on midazolam hypnotic requirements. Reg Anesth Pain
Med. 1996;21:209-13.
39. Banister CF, Brosius KK,Sigl JC. et al. The effect of Bispectral
Index Monitoring on Anesthetic Use and Recovery in Children
Anesthetized with Sevoflurane in Nitrous Oxide. Anesth Analg
2001;92:877-81.
40. Payne F,Sebel PS, Glass PSA, et al. Bispectral indeks (BIS)
monitoring allows faster emergence from propofol alfentanil/N2O anesthesia. Anesthesiology 1996;85:1056-61.
41. Song D, Vlymen J, White PF, et al. Is the Bispectral index
useful in predicting fast- tracking after ambulatory anaesthesia
with propofol and desflurane? Anesth Analg 1998;87:20-3.
42. Song D, Girish PJ,White PF. Titration of volatile anesthetics
using bispectral index facilitates recovery after ambulatory anesthesia. Anesthesiology1997;87:842-8.
43. Guignard B, Coste C, Menigaux C et al. Reduced isoflurane
consumption with bispectral index monitoring. Acta Anaesthesiol Scand 2001; 45:308-14.
44. Park KS, Hur EJ, Han KW, et al. Bispectral index does not
correlate with observer assesment of alertness and sedation
scores during 0,5 % bupivacaine epidural anesthesia with nitrous oxide sedation. Anesth Analg 2006;103;385-9.
45. White PF, White LD: Cost containment in the operating room
Who is responsible (editorial). J Clin Anesth 1994;6:351-6.
46. Watcha MF, White PF: Economics of anaesthetic practice.
Anesthesiology 1997; 86:1170-96.
47. Struys MMR, Somers AAL, van Den Eynde N, et al. Cost-
reduction analysis of propofol versus sevoflurane: maintenance
of anaesthesia for gynaecological surgery using the bispectral
index. Eur J Anaesthesiol 2002;19:727-34.
48. Hankala AY, Vakkuri A, Annila P, et al. EEG bispectral index
monitoring in sevofluran or propofol anaesthesia: analysis of
direct costs and immediate recovery. Acta Anaesthesiol Scand
1999;43:545-9.
49. Johansen JW, Sigl JC. Bispectral index (BİS) monitoring: cost
analysis and anesthetic outcome. Anesthesiology 1997;87:434-
5.

Thank you for copying data from http://www.arastirmax.com