Bispectral index variations during tracheal suction in mechanically ventilated critically ill patients: effect of an alfentanil bolus.
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.
Brocas
Elsa
E
Department of Anesthesiology and Surgical ICU, University of Paris 7, Bichat-Claude Bernard Hospital, Paris, France.
Dupont
Hervé
H
Paugam-Burtz
Catherine
C
Servin
Frédérique
F
Mantz
Jean
J
Desmonts
Jean-Marie
JM
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
D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D015760:Alfentanil