Bispectral Index Changes Following Boluses of Commonly Used Intravenous Medications During Volatile Anesthesia Identified From Retrospective Data.

Autor:	Schnetz MP; From the Department of Anesthesiology and Perioperative Medicine, School of Medicine., Reon BJ; From the Department of Anesthesiology and Perioperative Medicine, School of Medicine., Ibinson JW; From the Department of Anesthesiology and Perioperative Medicine, School of Medicine.; Clinical and Translational Science Institute., Kaynar M; From the Department of Anesthesiology and Perioperative Medicine, School of Medicine.; Department of Critical Care Medicine, School of Medicine., Mahajan A; From the Department of Anesthesiology and Perioperative Medicine, School of Medicine.; Department of Biomedical Informatics, School of Medicine.; Department of Bioengineering, Swanson School of Engineering., Vogt KM; From the Department of Anesthesiology and Perioperative Medicine, School of Medicine.; Clinical and Translational Science Institute.; Department of Bioengineering, Swanson School of Engineering.; Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania.
Jazyk:	angličtina
Zdroj:	Anesthesia and analgesia [Anesth Analg] 2024 Mar 01; Vol. 138 (3), pp. 635-644. Date of Electronic Publication: 2023 Aug 15.
DOI:	10.1213/ANE.0000000000006633
Abstrakt:	Background: Although patients are commonly monitored for depth of anesthesia, it is unclear to what extent administration of intravenous anesthetic medications may affect calculated bispectral (BIS) index values under general anesthesia. Methods: In a retrospective analysis of electronic anesthesia records from an academic medical center, we examined BIS index changes associated with 14 different intravenous medications, as administered in routine practice, during volatile-based anesthesia using a novel screening approach. Discrete-time windows were identified in which only a single drug bolus was administered, and subsequent changes in the BIS index, concentration of volatile anesthetic, and arterial pressure were analyzed. Our primary outcome was change in BIS index, following drug administration. Adjusted 95% confidence intervals were compared to predetermined thresholds for clinical significance. Secondary sensitivity analyses examined the same outcomes, with available data separated according to differences in baseline volatile anesthetic concentrations, doses of the administered medications, and length of time window. Results: The study cohort was comprised of data from 20,170 distinct cases, 54.7% of patients were men, with a median age of 55. In the primary analysis, ketamine at a median dose of 20 mg was associated with a median (confidence limits) increase in BIS index of 3.8 (2.5-5.0). Midazolam (median dose 2 mg) was associated with a median decrease in BIS index of 3.0 (1.5-4.5). Neither of these drug administrations occurred during time periods associated with changes in volatile anesthetic concentration. Analysis for dexmedetomidine was confounded by concomitant decreases in volatile anesthetic concentration. No other medication analyzed, including propofol and common opioids, was associated with a significant change in BIS index. Secondary analyses revealed that similar BIS index changes occurred when midazolam and ketamine were administered at different volatile anesthetic concentrations and different doses, and these changes persisted 11 to 20 minutes postadministration. Conclusions: Modest, but persistent changes in BIS index occurred following doses of ketamine (increase) and midazolam (decrease) during periods of stable volatile anesthetic administration. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2023 International Anesthesia Research Society.)
Databáze:	MEDLINE
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