Impact of bispectral index monitoring on stress response and propofol consumption in patients undergoing coronary artery bypass surgery
| Autor: | Michael Bauer, Wolfram Wilhelm, Sascha Kreuer, Reinhard Larsen, Andreas Brandt, Thomas Kraemer, Hans Anton Adams, Gudrun Hoff |
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| Rok vydání: | 2004 |
| Předmět: |
Male
Epinephrine Hydrocortisone Remifentanil Gas Chromatography-Mass Spectrometry law.invention Coronary artery bypass surgery Norepinephrine Double-Blind Method Piperidines law Stress Physiological Monitoring Intraoperative medicine Cardiopulmonary bypass Humans Prospective Studies Infusions Intravenous Propofol Aged Cardiopulmonary Bypass business.industry Interleukin-6 Hemodynamics Electroencephalography Middle Aged Interleukin-10 Anesthesiology and Pain Medicine Bypass surgery Anesthesia Bispectral index Anesthetic Anesthesia Intravenous Female business Anesthetics Intravenous medicine.drug |
| Zdroj: | Anesthesiology. 101(5) |
| ISSN: | 0003-3022 |
| Popis: | Background Bispectral Index (BIS)-titrated administration allows a reduction of propofol infusion rates in patients undergoing surgery. Resulting differences in anesthetic depth might affect the stress response to surgery involving neural circuitry not reflected in the electroencephalogram. Methods Forty patients scheduled to undergo elective coronary artery bypass grafting receiving a background infusion of remifentanil (0.3 microg . kg . min) were anesthetized with intravenous propofol delivered by target-controlled infusion according to the Marsh pharmacokinetic model under BIS monitoring. In a randomized, prospective design, 20 patients received propofol at a target concentration of 3 microg/ml, whereas in 20 patients propofol was titrated to maintain a BIS value of 40-50. Plasma concentrations of propofol (by means of gas chromatography-mass spectrometry), epinephrine, norepinephrine (by means of high-pressure liquid chromatography), cortisol (by means of radioimmunoassay), and interleukins 6 and 10 (by means of enzyme-linked immunosorbent assay) were measured repeatedly throughout surgery. Results BIS monitoring allowed a 30% reduction of propofol infusion rates and a similar decrease in plasma propofol concentrations in the BIS group without affecting the stress response to surgery for the group mean. None of the patients reported awareness during a standardized interview. Interestingly, propofol-remifentanil anesthesia blunted the release of epinephrine and cortisol to bypass surgery completely even when the propofol infusion rate was reduced according to BIS values. Conclusions Total intravenous anesthesia using propofol-remifentanil effectively attenuates the neurohumoral stress response to coronary bypass surgery involving cardiopulmonary bypass. Titration of propofol using BIS allows for significant reduction of propofol consumption, with only minor effects on stress response under these conditions. |
| Databáze: | OpenAIRE |
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