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Excerpt
Method: 24 patients scheduled for cardiac surgery were studied after informed consent. After premedication the patients were taken to the operating room. BIS was monitored continuously (A-2000 TM Monitor) besides standard monitoring. Anaesthesia was induced in all patients with a loading dose of propofol 1-1.5 mg kg−1 with either fentanyl 7.5-10 μg kg−1 in 12 patients (Group A) or remifentanil 0.5−1 μg kg−1 in 12 patients (Group B). Thereafter we maintained the anaesthesia with a continuous infusion of propofol 3-5 mg kg−1 h−1 and fentanyl 4-6 μg kg−1 h−1 or remifentanil 0.3-0.7 μg kg−1 h−1. To facilitate intubation, pancuronium (0.1 mg kg−1) was given after loss of response (LOR = no longer responding to loud, verbal command). BIS was registered before and after induction (ind), intubation (ETT), incision (inc), sternotomy (stern), during ECC (30-33 °C), at the end of extracorporeal circulation (ECC) and at sternal closure (sc). The data were analysed using the paired Student's t-test. Patients were interviewed on the first and second postoperative day for both explicit or implicit recall from the perioperative period.
Results: The table shows the BIS values at different time-points during anaesthesia and surgery for Groups A and B. The mean BIS value decreased equally for both groups (P < 0.01). There was no consistent trend of increase or decrease of the recorded BIS values during ECC in any of the patients.
Conclusion: The results of the present study indicate that the hypnotic component of anaesthesia, propofol infusion with either fentanyl or remifentanil, as estimated by the BIS values produced adequate anaesthetic depth, which did not change upon initiation and during ECC. No patient reported any event consistent with explicit or implicit recall from the perioperative period.
