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2012, Number 1

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Rev Mex Anest 2012; 35 (1)

TCI (Target Controlled Infusion) with Propofol-Fentanyl associated with changes in the Bispectral Index in neurosurgical patients. BIS-guided intravenous anesthesia

Jaramillo-Magaña JJ

Language: Spanish
References: 56
Page: 26-39
PDF size: 215.63 Kb.


ABSTRACT

Background: Different studies establish advantages of intravenous on volatile anesthesia for neurosurgical patients. However, the use of inhaled agents continues being popular, because controlled clinical studies have not been realized either that demonstrate these advantages convincingly. In this work, the Rugloop for the administration of TCI with propofol - Fentanyl to provide anesthesia in neurosurgical patients, were used with the purpose to evaluate the characteristics of the propofol Schnider model and their efficacy in BIS-guided intravenous anesthesia. The goal of this work was to evaluate the TCI of propofol - fentanyl in neurosurgical patients and to establish a guide for its management with base in the effects of propofol on EEG (BIS). Methods: Thirty and four patients, 25 – 55 years old, ASA 1 – 3, and normal weight, scheduled to undergo elective non-vascular neurosurgical procedures were prospectively studied. Schnider model was used to infuse propofol TCI. The goal was to reach a BIS target of 50 during induction and to maintain it between 40 and 60 during maintenance. The Scott model for fentanyl TCI, was used to provide analgesia during induction and maintenance. A dose-response curve was adjusted to evaluate the relationships between BIS and estimated concentration of propofol. Performance error of the model also was evaluated. Results: TCI propofol infusion was able to provide anesthesia induction and maintenance for all patients. Lost of consciousness was achieved 1.6 minutes after propofol infusion for all patients (47 seconds for 50% of the patients). Propofol estimated concentrations required to reach target BIS (40 – 60), occurred with 2.2 – 3.5 µg/mL. The recover of consciousness was reached between 8 – 13 minutes, with a corresponding target BIS (84 – 89) between 1.1 – 1.5 µg/mL. Performance error of the model was 6.9%. Conclusions: TCI propofol – BIS guided anesthesia is clinically feasible, reliable and safe in non-vascular neurosurgical patients. The performance of the Schnider model, may be the recommended model to be used for TCI anesthesia in these population, but must be carefully evaluated in other non-neurosurgical populations.


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