[The value of monitoring the bispectral index of the EEG for the management of hypertension during laparoscopic surgery].
OBJECTIVE
Assessment of the usefulness of Bispectral Index of the EEG (BIS) for the management of hypertension during laparoscopic surgery.


METHODS
Preliminary, non-randomized study.


METHODS
15 patients undergoing laparoscopic surgery.


METHODS
Anaesthesia by TCI of propofol and boluses of fentanyl in order to maintain fentanyl effect site concentration above 2 ng.mL-1 according to Scott kinetics model. Mean arterial pressure (MAP), heart rate (HR) and BIS were recorded. BIS values between 40 and 60 and MAP between 80 to 120% of preinduction values were maintained using a Gurman like decision matrix.


RESULTS
MAP rose significantly after insufflation while variations of HR and BIS were not significant.


CONCLUSIONS
During laparoscopy, factors other than pain can be responsible for hypertension. Nevertheless in clinical practice, inadequate anaesthesia should be ruled out before considering other mechanisms for hypertension. In this study, hypnosis remained adequate with a BIS under 60, and analgesia was considered sufficient as demonstrated by a good stability of the BIS despite nociceptive stimuli. This suggests that more specific haemodynamic factors were responsible for the observed rise in arterial pressure.


CONCLUSIONS
Associating BIS monitoring and MAP in a modified Gurman decision matrix may allow more judicious therapeutic choices for hypertension during laparoscopic surgery.
Mavoungou
P
P
Département d'anesthésiologie, clinique Mutualiste, Nantes, France.
Billard
V
V
Moussaud
R
R
Potiron
L
L
D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D003661:Decision Support Techniques; D004569:Electroencephalography; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D007327:Insufflation; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D015742:Propofol / Q000008:administration & dosage; D012815:Signal Processing, Computer-Assisted
D018686:Anesthetics, Intravenous; D005283:Fentanyl; D015742:Propofol