Journal of Clinical Monitoring and Computing

, Volume 26, Issue 6, pp 459–463 | Cite as

The utility of bispectral index monitoring for sedated patients treated with low-dose remifentanil

  • Takao KatoEmail author
  • Toshiya Koitabashi
  • Takashi Ouchi
  • Ryohei Serita
Original Research


The aim of the present study was to determine the effect of low-dose remifentanil on the monitoring quality of the Bispectral index for mechanically ventilated patients. Twelve patients who underwent elective surgery and required mechanical ventilation post-operatively were enrolled in this study with written informed consent. Eligible patients were divided into two groups. Patients in the remifentanil group received low-dose remifentanil (0.05–0.125 μg/kg/min) and propofol (1–3 mg/kg/h). Patients in the control group received propofol (1–3 mg/kg/h). Levels of sedation were evaluated by both the Richmond Agitation Sedation Scale (RASS) and BIS monitor (A2000-XP, version 4.0, Aspect Medical Systems, Newton, USA). Monitoring quality was assessed by a correlation between RASS and BIS values. These values were assessed by single regression analysis and a P value of <0.05 was considered significant. There was a significant correlation between RASS and BIS values (P = 3 × 10−12, R 2 = 0.67) in the remifentanil group, but not in the control group (P = 0.50, R 2 = 0.057). The administration of low-dose remifentanil makes BIS a more precise tool for sedated patients under mechanical ventilation in the ICU.


Bispectral index Remifentanil Richmond agitation sedation scale Monitoring quality 


Conflict of interest



  1. 1.
    Johansen JW, Sebel PS. Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology. 2000;93:1336–44.PubMedCrossRefGoogle Scholar
  2. 2.
    Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology. 1998;89:980–1002.PubMedCrossRefGoogle Scholar
  3. 3.
    Liu SS. Effects of bispectral index monitoring on ambulatory anesthesia: a meta-analysis of randomized controlled trials and a cost analysis. Anesthesiology. 2004;101:311–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Pavlin JD, Souter KJ, Hong JY, Freund PR, Bowdle TA, Bower JO. Effects of bispectral index monitoring on recovery from surgical anesthesia in 1,580 inpatients from an academic medical center. Anesthesiology. 2005;102:566–73.PubMedCrossRefGoogle Scholar
  5. 5.
    Bruhn J, Myles PS, Sneyd R, Struys MM. Depth of anaesthesia monitoring: what’s available, what’s validated and what’s next? Br J Anaesth. 2006;97:85–94.PubMedCrossRefGoogle Scholar
  6. 6.
    Ely EW, Truman B, Shintani A, Thomason JWW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003;289:2983–91.PubMedCrossRefGoogle Scholar
  7. 7.
    LeBlanc JM, Dasta JF, Kane-Gill SL. Role of the bispectral index in sedation monitoring in the ICU. Ann Pharmacother. 2006;40:490–500.PubMedCrossRefGoogle Scholar
  8. 8.
    Simmons LE, Riker RR, Prato BS, Fraser GL. Assessing sedation during intensive care unit mechanical ventilation with the bispectral index and the sedation-agitation scale. Crit Care Med. 1999;27:1499–504.PubMedCrossRefGoogle Scholar
  9. 9.
    Riker RR, Fraser GL, Simmons LE, Wilkins ML. Validating the sedation-agitation scale with the bispectral index and visual analog scale in adult ICU patients after cardiac surgery. Intensive Care Med. 2001;27:853–8.PubMedCrossRefGoogle Scholar
  10. 10.
    De Deyne C, Struys M, Decruyenaere J, Creupelandt J, Hoste E, Colardyn F. Use of continuous bispectral EEG monitoring to assess depth of sedation in ICU patients. Intensive Care Med. 1998;24:1294–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, Chalfin DB, Masica MF, Bjerke HS, Coplin WM, Crippen DW, Fuchs BD, Kelleher RM, Marik PE, Nasraway SA Jr, Murray MJ, Peruzzi WT, Lumb PD. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002;30:119–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Kress JP, Pohlman AS, Hall JB. Sedation and analgesia in the intensive care unit. Am J Respir Crit Care Med. 2002;166:1024–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Muellejans B, Matthey T, Scholpp J, Schill M. Sedation in the intensive care unit with remifentanil/propofol versus midazolam/fentanyl: a randomised, open-label, pharmacoeconomic trial. Crit Care. 2006;10:R91.PubMedCrossRefGoogle Scholar
  14. 14.
    Park G, Lane M, Rogers S, Bassett P. A comparison of hypnotic and analgesic based sedation in a general intensive care unit. Br J Anaesth. 2007;98:76–82.PubMedCrossRefGoogle Scholar
  15. 15.
    Carrer S, Bocchi A, Candini M, Donegà L, Tartari S. Short term analgesia based sedation in the intensive care unit: morphine vs remifentanil + morphine. Minerva Anestesiol. 2007;73:327–32.PubMedGoogle Scholar
  16. 16.
    Sessler CN, Varney K. Patient-focused sedation and analgesia in the ICU. Chest. 2008;133:552–65.PubMedCrossRefGoogle Scholar
  17. 17.
    Haenggi M, Ypparila-Wolters H, Buerki S, Schlauri R, Korhonen I, Takala J, Jakob SM. Auditory event-related potentials, bispectral index, and entropy for the discrimination of different levels of sedation in intensive care unit patients. Anesth Analg. 2009;109:807–16.PubMedCrossRefGoogle Scholar
  18. 18.
    Moerman AT, Herregods LL, De Vos MM, Mortier EP, Struys MM. Manual versus target-controlled infusion remifentanil administration in spontaneously breathing patients. Anesth Analg. 2009;108:828–34.PubMedCrossRefGoogle Scholar
  19. 19.
    Levine S, Nguyen T, Taylor N, Friscia ME, Budak MT, Rothenberg P, Zhu J, Sachdeva R, Sonnad S, Kaiser LR, Rubinstein NA, Powers SK, Shrager JB. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med. 2008;358:1327–35.PubMedCrossRefGoogle Scholar
  20. 20.
    Sassoon CS, Zhu E, Caiozzo VJ. Assist-control mechanical ventilation attenuates ventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med. 2004;170:626–32.PubMedCrossRefGoogle Scholar
  21. 21.
    Novaes MA, Knobel E, Bork AM, Pavão OF, Nogueira-Martins LA, Ferraz MB. Stressors in ICU: perception of the patient, relatives and health care team. Intensive Care Med. 1999;25:1421–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Renna M, Wigmore T, Mofeez A, Gillbe C. Biasing effect of the electromyogram on BIS: a controlled study during high-dose fentanyl induction. J Clin Monit Comput. 2002;17:377–81.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Takao Kato
    • 1
    Email author
  • Toshiya Koitabashi
    • 1
  • Takashi Ouchi
    • 1
  • Ryohei Serita
    • 1
  1. 1.Department of AnesthesiologyIchikawa General Hospital, Tokyo Dental CollegeIchikawa-cityJapan

Personalised recommendations