title: Bispectral index monitoring during infant cardiac surgery: relationship of BIS to the stress response and plasma fentanyl levels.
abstract: BACKGROUND
  We evaluated the relationship of the bispectral index (BIS) to commonly used indices of depth of anaesthesia in 19 infants enrolled in a prospective study of the stress response to hypothermic cardiopulmonary bypass.
  
  
  METHODS
  Group 1 (n=8) received high-dose fentanyl by bolus technique; group 2 (n=6) received high-dose fentanyl by continuous infusion; and group 3 (n=5) received a fentanyl-midazolam infusion. Blood pressure (BP), heart rate (HR) and plasma epinephrine, norepinephrine, cortisol, ACTH, glucose, lactate and fentanyl were analysed 15 min postinduction, 15 min poststernotomy, 15 min on CPB during cooling and during skin closure.
  
  
  RESULTS
  Mean BIS (SD) values for all 19 patients were 45.3 (12.3), 40.4 (14.5), 24.4 (12.4) and 47.9 (13.9), at the successive time points. No significant differences were observed in changes in BIS over time between the groups. A significant correlation was found 15 min postinduction between BIS and BP (systolic r=0.51, mean r=0.56) in all groups, but not between BIS and HR. BIS did not correlate with BP or HR at any other time point. There was no significant correlation between BIS and hormonal, biochemical or plasma fentanyl levels for any group at any time point.
  
  
  CONCLUSIONS
  We were unable to demonstrate a relationship between the BIS and haemodynamic, metabolic or hormonal indices of anaesthetic depth. Further evaluation of the BIS algorithm is required in neonates and infants.
authors.affiliation: Department of Anesthesia, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: B D
authors.initials: BD
authors.lastname: Kussman
authors.forename: E M
authors.initials: EM
authors.lastname: Gruber
authors.forename: D
authors.initials: D
authors.lastname: Zurakowski
authors.forename: D D
authors.initials: DD
authors.lastname: Hansen
authors.forename: L J
authors.initials: LJ
authors.lastname: Sullivan
authors.forename: P C
authors.initials: PC
authors.lastname: Laussen
mesh_terms: D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000097:blood*; D015415:Biomarkers; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D004311:Double-Blind Method; D004569:Electroencephalography; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000097:blood*; D006439:Hemodynamics / Q000502:physiology; D006728:Hormones / Q000097:blood; D006801:Humans; D007036:Hypothermia, Induced; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D013312:Stress, Physiological / Q000503:physiopathology*
chemical_list: D018686:Anesthetics, Intravenous; D015415:Biomarkers; D006728:Hormones; D005283:Fentanyl