23 de fevereiro de 2011

Artigo: Impact of deep hypothermic circulatory arrest on the BIS index

Journal of Clinical Anesthesia (2010) 22, 340–345

Stephan Ziegeler MD (Staff Anesthesiologist)ª, Heiko Buchinger MD (Staff Anesthesiologist)ª, Wolfram Wilhelm MD (Director)b, Reinhard Larsen MD (Director)ª, Sascha Kreuer MD (Staff Anesthesiologist)ª

ªDepartment of Anesthesiology, Intensive Care Medicine and Pain Therapy, University of Saarland, 66421 Homburg/Saar, Germany
bDepartment of Anesthesiology and Intensive Care Medicine, Klinikum Luenen-St.-Marien-Hospital, 44534 Luenen, Germany

Received 7 January 2008; revised 4 September 2009; accepted 26 September 2009

Keywords: Bispectral index; Deep hypothermic circulatory arrest; Extracorporeal circulation; Hypothermia

Study Objective: To investigate the influence of duration of deep hypothermic circulatory arrest (DHCA) on recovery of the bispectral index (BIS).
Design: Prospective cohort study.
Setting: Operating room of university teaching hospital.
Patients: 30 adult, ASA physical status III and IV patients scheduled for cardiac surgery with extracorporeal circulation (ECC) and DHCA.
Interventions: There were no study-specific interventions undertaken with the study patients.
Measurements: After induction of anesthesia, propofol and sufentanil were used for maintenance. Duration until BIS values reached indices of 10, 20, and 30 after DHCA was measured. ΔBIS was defined as the difference between BIS before the start of ECC and after DHCA at the same nasopharyngeal body temperature. Data are means ± SD (ranges).
Main Results: Duration of DHCA was 24 ± 15 min (8-71 min). The deepest nasopharyngeal temperature was 20.1 ± 2.7°C at the end of DHCA. BIS reduction was 1.8/°C. At the end of DHCA, BIS was 2 ± 6 and at the end of ECC, BIS was 33 ± 11. Duration until BIS reached a value of 10 (BIS10) was 23 ± 21 min (0-83 min); until BIS reached 20 (BIS20): 36 ± 36 min (0-140 min); and until BIS reached 30 (BIS30): 43 ± 29 min (1-130 min). Regression analysis between duration of DHCA and BIS10 was R = 0.76; BIS20: R = 0.67; and BIS30: R = 0.54.
Conclusion: Deep hypothermia influences BIS linearly. In addition, there appears to be a reasonable correlation between recovery of BIS values and duration of DHCA.

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