title: Bispectral index variations during tracheal suction in mechanically ventilated critically ill patients: effect of an alfentanil bolus.
abstract: OBJECTIVE
  To evaluate the impact of an alfentanil dose on bispectral index (BIS) variations during tracheal suction in ICU sedated patients.
  
  
  METHODS
  A prospective open-label pilot study in a 12-bed surgical ICU in a university-affiliated, tertiary referral hospital.
  
  
  METHODS
  Eleven sedated (midazolam plus fentanyl) mechanically ventilated patients.
  
  
  METHODS
  Continuous monitoring of BIS with arterial pressure and heart rate before, during, and after tracheal suction without (control period) and with an intravenous bolus of alfentanil (15 microg/kg, alfentanil period) before suction.
  
  
  RESULTS
  Steady-state BIS value was 61+/-8 for the control period and 59+/-7 for the alfentanil period. Blood pressure and heart rate were similar between baseline periods. One minute after tracheal suction, a significant increase in BIS level was observed in the control period, which remained significantly different from the alfentanil period until 10 min later. Significant higher systolic and diastolic blood pressure and heart rate were observed during the control period than the alfentanil period. However, no difference in Ramsay scores was observed between the two periods.
  
  
  CONCLUSIONS
  An alfentanil bolus of 15 microg/kg markedly reduced the increase in BIS values, blood pressure, and heart rate observed immediately after tracheal suction. Therefore BIS monitoring in ICU may help to improve analgesia during invasive events.
authors.affiliation: Department of Anesthesiology and Surgical ICU, University of Paris 7, Bichat-Claude Bernard Hospital, Paris, France.
authors.forename: Elsa
authors.initials: E
authors.lastname: Brocas
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
authors.forename: Catherine
authors.initials: C
authors.lastname: Paugam-Burtz
authors.forename: Frédérique
authors.initials: F
authors.lastname: Servin
authors.forename: Jean
authors.initials: J
authors.lastname: Mantz
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Desmonts
mesh_terms: D000328:Adult; D000368:Aged; D015760:Alfentanil / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D016292:Procedural Sedation / Q000145:classification*; D016638:Critical Illness / Q000628:therapy*; D016903:Drug Monitoring / Q000379:methods; D004569:Electroencephalography; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D010865:Pilot Projects; D011446:Prospective Studies; D012121:Respiration, Artificial; D013396:Suction; D014132:Trachea
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D015760:Alfentanil