Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Use of bispectral monitoring in cardiosurgery

Authors: M.M. Rybka, Kh.E. Yusupov, X.E. Diasamidze

Company:
A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russia, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

UDC: 616.12-089]-07

Link: Clinical Physiology of Blood Circulaiton. 2016; 13 (3): 125-130

Quote as: Rybka M.M., Yusupov Kh.E., Diasamidze КЦ. Use of bispectral monitoring in cardiosurgery. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2016; 13 (3): 125-130 (in Russ.).

Received / Accepted:  21.07.2016/21.07.2016

Download
Full text:  

Abstract

Patients cardiosurgical profile represent a unique group of patients in terms of all possible combinations of high anesthetic risk of perioperative period. Monitoring the depth of anesthesia, based on an assessment of autonomic functions is difficult, since they are absent during cardiopulmonary bypass; assessment of the concentration of volatile agent at the end of exhalation uninformative, as during cardiopulmonary bypass blood flow to the lungs is minimal. Empirical anesthetic dosing regimens based on target- controlled infusion does not take into account the changes in pharmacokinetic and pharmacodynamic drug during cardiopulmonary bypass. In addition, patients of cardiosurgery profile typically can not tolerate standard anesthetic dose calculated without adverse hemodynamic effects. Finally, in some cases anesthesiologists use smaller doses of narcotic analgesics and anesthetics, particularly during the induction due to their potentially negative in case of overdose, the effect on the myocardial contractile function. Considering all the above, it is not surprising that the incidence of unplanned intraoperative wakefulness in cardiac surgical patients is much higher than in the general surgical profile of patients. All of the above actualizes the need for a bispectral monitoring in cardiac surgery.

References

  1. Ahonen J., Olkkola R.T., Hynynen M. et al. Comparison of alfentanil, fentanil and sufentanil for total intravenous anaesthesia with propofol in patients undergoing coronary artery bypass surgery. Br. J. Anaesth. 2000; 85 (4): 533-40.
  2. Yoshitani К., Kawaguchi M., Takahashi M. et al. Plasma propofol concentration and EEG burst suppression ratio during normothermic cardiopulmonary bypass. Br. J. Anaesth. 2003; 90 (2): 122-6.
  3. Barry A.E., Chaney M.A., London M.J. Anesthetic management during cardiopulmonary bypass: A systematic review. Anesth. Analg. 2015; 120 (4): 749-69.
  4. Liu E.H., Dhara S.S. Monitoring oxygenator expiratory isoflurane concentrations and the bispectral index to guide isoflurane requirements during cardiopulmonary bypass. J. Cardiothorac. Vasc. Anesth. 2005; 19 (4): 485-7.
  5. Chandran Mahaldar D.A., Gadhinglajkar S., Sreed- har R. Sevoflurane requirement to maintain bispectral index-guided steady-state level of anesthesia during the rewarming phase of cardiopulmonary bypass with moderate hypothermia. J. Cardiothorac. Vasc. Anesth. 2013; 27: 59-62.
  6. Fiset P, Mathers L., Engstrom R., Fitzgerald D., Brand S.C., Hsu F., Shafer S.L. Pharmacokinetics of computer-controlled alfentanil administration in children undergoing cardiac surgery. Anesthesiology. 1995; 83 (5): 944-55.
  7. Bailey J.M., Mora C.T., Shafer S.L. Pharmacokinetics of propofol in adult patients undergoing coronary revascularization. The Multicenter Study of Perioperative Ischemia Research Group. Anesthesiology. 1996; 84: 1288-97.
  8. Mashour G.A., Shanks A., Tremper K.K., Kheter- pal S., Turner C.R., Ramachandran S.K. et al. Prevention of intraoperative awareness with explicit recall in an unselected surgical population: a randomized comparative effectiveness trial. Anesthesiology. 2012; 117 (4): 717-25.
  9. Nielsen D.V., Hansen M.K., Johnsen S.P, Hansen M., Hindsholm K., Jakobsen C.J. Health outcomes with and without use of inotropic therapy in cardiac surgery: results of a propensity scorematched analysis. Anesthesiology. 2014; 120 (5): 1098-108.
  10. Myles PS., Leslie K., McNeil J., Forbes A., Chan M.T. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004; 363 (9423): 1757-63.
  11. Avidan M.S., Zhang L., Burnside B.A., Finkel K.J., Searleman A.C., Selvidge J.A. et al. Anesthesia awareness and the bispectral index. N. Engl. J. Med. 2008; 358 (11): 1097-108.
  12. Avidan M.S., Jacobsohn E., Glick D., Burnside B.A., Zhang L., Villafranca A. et al.; BAG-RECALL Research Group. Prevention of intraoperative awareness in a high-risk surgical population. N. Engl. J. Med. 2011; 365 (7): 591-600.
  13. Avidan M.S., Mashour G.A. Prevention of intraoperative awareness with explicit recall: making sense of the evidence. Anesthesiology. 2013; 118 (2): 449-56.
  14. Dowd N.P., Cheng D.C., Karski J.M., Wong D.T., Munro J.A., Sandler A.N. Intraoperative awareness in fast-track cardiac anesthesia. Anesthesiology. 1998; 89 (5): 1068-73.
  15. Ranta S.O., Herranen P, Hynynen M. Patients' conscious recollections from cardiac anesthesia. J. Cardiothorac. Vasc. Anesth. 2002; 16 (4): 426-30.
  16. De Hert S.G., Van der Linden P.J., Cromheecke S., Meeus R., Nelis A., Van Reeth V. et al. Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration. Anesthesiology. 2004; 101 (2): 299-310.
  17. Pagel P. S. Myocardial protection by volatile anesthetics in patients undergoing cardiac surgery: a critical review of the laboratory and clinical evidence. J. Cardiothorac. Vasc. Anesth. 2013; 27 (5): 972-82.
  18. Myers G.J., Voorhees C., Eke B., Johnstone R. The effect of Diprivan (propofol) on phosphorylcholine surfaces during cardiopulmonary bypass - an in vitro investigation. Perfusion. 2009; 24 (5): 349-55.
  19. Arya V.K., Kumar A., Thingnam S.K. Propofol infusion into the pump during cardiopulmonary bypass: is it safe and effective? J. Cardiothorac. Vasc. Anesth. 2004; 18: 122-3.
  20. Prasser C., Zelenka M., Gruber M., Philipp A., Key- ser A., Wiesenack C. Elimination of sevoflurane is reduced in plasmatight compared to conventional membrane oxygenators. Eur. J. Anaesthesiol. 2008; 25 (2): 152-7.
  21. Council Directive 93/42/EEC, 1993. Available at: http://eurlex. europa.eu/LexUriServ/LexUriServ.do? uri=CONSLEG:19 93L0042: 20071011: EN: PDF. Accessed June 2, 2014.
  22. . Nigro Neto C., Arnoni R., Rida B.S., Landoni G., Tardelli M.A. Randomized trial on the effect of sevoflurane on polypropylene membrane oxygenator performance. J. Cardiothorac. Vasc. Anesth. 2013; 27 (5): 903-7.
  23. Fromes Y, Gaillard D., Ponzio O., Chauffert M., Gerhardt M.F., Deleuze P., Bical O.M. Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur. J. Cardiothorac. Surg. 2002; 22 (4): 527-33.
  24. Anastasiadis K., Asteriou C., Antonitsis P., Argiria- dou H., Grosomanidis V., Kyparissa M. et al. Enhanced recovery after elective coronary revascularization surgery with minimal versus conventional extracorporeal circulation: a prospective randomized study. J. Cardiothorac. Vasc. Anesth. 2013; 27: 859-64.
  25. Sakamoto H., Mayumi T, Morimoto Y., Kem- motsu O., Wakisaka H., Ohno T Sevoflurane metabolite production in a small cohort of coronary artery bypass graft surgery patients. J. Cardiothorac. Vasc. Anesth. 2002; 16 (4): 463-7.
  26. Cooper S., Levin R. Near catastrophic oxygenator failure. Anesthesiology. 1987; 66: 101-2.
  27. Walls J.T, Curtis J.J., McClatchey B.J., Wood D. Adverse effects of anesthetic agents on polycarbonate plastic oxygenators. J. Thorac. Cardiovasc. Surg. 1988; 96 (4): 667-8.
  28. Maltry D.E., Eggers G.W. Jr. Isoflurane-induced failure of the Bentley-10 oxygenator. Anesthesiology. 1987; 66 (1): 100-1.
  29. Lim H.S., Cho S.H., Kim D.K., Lee S.K., Ko S.H. Isoflurane cracks the polycarbonate connector of extracorporeal circuit. A case report. Korean J. Anesthesiol. 2010; 58 (3): 304-6.
  30. Vance J.L., Shanks A.M., Woodrum D.T. Intraoperative bispectral index monitoring and time to extubation after cardiac surgery: secondary analysis of a randomized controlled trial. BMC Anesthesiol. 2014; 14: 79.
  31. Mets B., Reich N.T, Mellas N., Beck J., Park S. Desflu- rane pharmacokinetics during cardiopulmonary bypass. J. Cardiothorac. Vasc. Anesth. 2001; 15 (2): 179-82.
  32. Wiesenack C., Wiesner G., Keyl C., Gruber M., Philipp A., Ritzka M. et al. In vivo uptake and elimination of isoflurane by different membrane oxygenators during cardiopulmonary bypass. Anesthesiology. 2002;
  33. 97 (1): 133-8.
  34. Nitzschke R., Wilgusch J., Kersten J.F., Trepte C.J., Haas S.A., Reuter D.A. et al. Changes in sevoflurane plasma concentration with delivery through the oxygenator during on-pump cardiac surgery. Br. J. Anaesth. 2013; 110 (6): 957-65.
  35. American Society of Anesthesiologists Task Force on intraoperative awareness. Practice advisory for intraoperative awareness and brain function monitoring: a report by the American society of anesthesiologists task force on intraoperative awareness. Anesthesiology. 2006; 104 (4): 847-64.
  36. Shepherd J., Jones J., Frampton G., Bryant J., Baxter L., Cooper K. Clinical effectiveness and cost- effectiveness of depth of anaesthesia monitoring (E- Entropy, Bispectral Index and Narcotrend): a systematic review and economic evaluation. Health Technol. Assess. 2013; 17 (34): 1-264.

 If you found mistakes, select text and press Alt+A