Abstract
Purpose
To assess if titration of sevoflurane using the bispectral index (BIS) monitor improves the early and intermediate recovery in geriatric outpatients undergoing brief urologic procedures under general anesthesia without muscle relaxants.
Methods
After a standardized induction with propofol and fentanyl, a laryngeal mask airway was inserted and sevoflurane was administered in combination with 60% nitrous oxide in oxygen for maintenance of anesthesia in spontaneously breathing outpatients. In the Control group (n = 25), sevoflurane and fentanyl were titrated according to standard clinical practice. In the BIS directed group (n = 25), sevoflurane was titrated to maintain a BIS value between 50 and 60, and supplemental fentanyl, 25 μgiv boluses were administered to treat tachypnea. The intraoperative anesthetic and analgesic requirements, as well as the times to eye opening, removal of the laryngeal mask airway device, response to simple commands, orientation to person and place, and postanesthesia care unit discharge eligibility (fast-track score of 14) were assessed at specific time intervals.
Results
The minimum alveolar concentration-hour of sevoflurane (0.25 ± 0.15 and 0.31 ± 0.2) and end-tidal concentrations of sevoflurane at the end of surgery (0.3 ± 0.3 and 0.4 ± 0.20%) did not differ significantly between the Control and BIS-directed groups, respectively. Although the percentage of patients requiring supplemental boluses of fentanyl was reduced in the BIS directed group (16vs 48%,P <0.05), the intraoperative BIS values and recovery times were similar in the two groups.
Conclusion
In this non-paralyzed elderly outpatient surgery population, the use of BIS monitoring for titrating the maintenance anesthetic (sevoflurane) failed to improve the early recovery process.
Résumé
Objectif
Évaluer si le titrage du sévoflurane à ľaide d’un moniteur d’index bispectral (BIS) améliore la récupération précoce et intermédiaire des patients ambulatoires âgés après une brève intervention urologique sous anesthésie générale sans myorelaxants.
Méthode
Après une induction normalisée avec du propofol et du fentanyl, un masque laryngé a été inséré et le sévoflurane administré en combinaison avec un mélange de protoxyde d’azote et d’oxygène à 60 % pour maintenir ľanesthésie chez des patients en ventilation spontanée. Dans le groupe témoin (n = 25), le sévoflurane et le fentanyl ont été dosés selon la pratique courante. Dans le groupe sous monitorage BIS (n = 25), le dosage visait à maintenir une valeur de BIS entre 50 et 60, et du fentanyl complémentaire, en bolus de 25 μg iv, a été administré pour traiter la tachypnée. ľanesthésique peropératoire et les besoins d’analgésiques, de même que le temps précédant ľouverture des yeux, le retrait du masque laryngé, la réponse à des commandes simples, la reconnaissance des gens et du lieu et la possibilité de quitter la salle de réveil (score séjour bref de 14) ont été notés à des intervalles spécifiques.
Résultats
La concentration-heure de sévoflurane (0,25 ± 0,15 et 0,31 ± 0,2) et les concentrations télé-expiratoires de fin d’opération (0,3 ± 0,3 et 0,4 ± 0,20 %) n’affichaient pas de différence significative entre les groupes témoin et de monitorage BIS respectifs. Le pourcentage de patients qui ont eu besoin de bolus complémentaires de fentanyl était plus bas avec le BIS (16 vs 48 %, P < 0,05), mais les valeurs peropératoires de BIS et le temps de récupération étaient similaires dans les deux groupes.
Conclusion
Dans cette population de patients ambulatoires âgés, opérés sans myorelaxants, ľusage du monitorage BIS pour le titrage de ľanesthésique de maintien (sévoflurane) n’a pu améliorer la récupération précoce.
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Zohar, E., Luban, I., White, P.F. et al. Bispectral index monitoring does not improve early recovery of geriatric outpatients undergoing brief surgical procedures. Can J Anesth 53, 20–25 (2006). https://doi.org/10.1007/BF03021523
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DOI: https://doi.org/10.1007/BF03021523