title: Fentanyl and midazolam anaesthesia for coronary bypass surgery: a clinical study of bispectral electroencephalogram analysis, drug concentrations and recall.
abstract: Bispectral index (BIS) was assessed as a monitor of depth of anaesthesia during fentanyl and midazolam anaesthesia for coronary bypass surgery. In 10 patients given morphine premedication, anaesthesia was induced with a combination of midazolam and fentanyl and thereafter maintained with a continuous infusion of a mixture of midazolam and fentanyl 5 and 50 micrograms kg-1 h-1, respectively. BIS was recorded continuously but not shown to the attending anaesthetist. Plasma concentrations of midazolam and fentanyl were measured five times during the procedure. An auditory stimulus was given during bypass. All patients were interviewed twice after operation for explicit and implicit recall. No patient had any anaesthetic complications. BIS decreased during anaesthesia, but varied considerably during surgery (range 36-91) with eight patients having values > 60. Midazolam and fentanyl drug concentrations did not correlate with BIS. No patient reported explicit or implicit recall. During clinically adequate anaesthesia with midazolam and fentanyl BIS varies considerably. The most likely reason is that BIS is not an accurate measure of the depth of anaesthesia when using this combination of agents.
authors.affiliation: Department of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Barr
authors.forename: R E
authors.initials: RE
authors.lastname: Anderson
authors.forename: S
authors.initials: S
authors.lastname: Samuelsson
authors.forename: A
authors.initials: A
authors.lastname: Owall
authors.forename: J G
authors.initials: JG
authors.lastname: Jakobsson
mesh_terms: D000161:Acoustic Stimulation; D000368:Aged; D000369:Aged, 80 and over; D019162:Anesthetics, Combined / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000097:blood / Q000494:pharmacology*; D001026:Coronary Artery Bypass; D004569:Electroencephalography / Q000187:drug effects*; D005283:Fentanyl / Q000097:blood / Q000494:pharmacology; D006801:Humans; D011939:Mental Recall / Q000187:drug effects*; D008874:Midazolam / Q000097:blood / Q000494:pharmacology; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl