Propofol and sufentanil titration with the bispectral index to provide anesthesia for coronary artery surgery.
BACKGROUND
To provide anesthesia for cardiac surgery, hypnotics and opioids are frequently titrated on variables such as mean arterial pressure and heart rate. In this study conducted in patients scheduled to undergo coronary artery bypass grafting, propofol and sufentanil, both administered by computer-controlled infusion, were titrated on the Bispectral Index (BIS) values using a predefined algorithm.


METHODS
After written informed consent, 110 patients, 95 men and 15 women aged 61 (9) yr [mean (SD)], were randomly allocated to receive predicted sufentanil effect site concentrations (Ce) of 0.5, 0.75, 1, 1.25, and 1.5 ng/ml, decreased by a third after sternotomy (groups 1-5). Target induction propofol concentration was 1.5 microg/ml and subsequently adjusted on BIS values. The following parameters were recorded: BIS values, predicted propofol Ce, the number of changes of propofol target, mean arterial pressure, heart rate, the number of bolus injection and doses of vasoconstrictor and vasodilator drugs, time to tracheal extubation, postoperative awareness and satisfaction scores, and cumulative morphine doses for the first postoperative day.


RESULTS
One patient randomized to group 1 required 0.75 ng/ml sufentanil Ce instead of 0.5 ng/ml for increased BIS values on tracheal intubation. BIS values were similar in the five groups. The predicted propofol Ce values were different (P < 0.05; analysis of variance) among the five groups: 1.59 (0.47) to 1.23 (0.25) microg/ml in group 1 and group 4, respectively. Significantly fewer changes of propofol target were required in group 4 as compared to group 1. There were no differences among the five groups for mean arterial pressure, heart rate, time to tracheal extubation, awareness, satisfaction scores, and morphine requirements.


CONCLUSIONS
These results suggest the BIS, as part of an algorithm that uses both the absolute BIS value and its increase following tracheal intubation, can be used to effectively titrate both propofol and sufentanil. A predicted sufentanil Ce of 1.25 ng/ml before and 0.8 ng/ml after sternotomy was associated with the lowest predicted propofol Ce and fewer changes of propofol target. Lower sufentanil concentrations required higher propofol concentrations and more frequent changes of the target propofol concentration and were associated with similar hemodynamic tolerance.
Forestier
François
F
Department of Anesthesia and Intensive Care, Centre Hospitalier Universitaire (CHU) de Bordeaux, France.
Hirschi
Marie
M
Rouget
Pierre
P
Rigal
Jean-Cristophe
JC
Videcoq
Michel
M
Girardet
Pierre
P
Durand
Michel
M
Maitrasse
Bruno
B
Girard
Claude
C
Lehot
Jean-Jacques
JJ
Du Grés
Bernard
B
Sellin
Michel
M
Depoix
Jean-Pol
JP
Janvier
Gérard
G
Longrois
Dan
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000768:Anesthesia, General; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001364:Awareness / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D003243:Consciousness; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010149:Postoperative Pain / Q000188:drug therapy; D011182:Postoperative Care; D011237:Predictive Value of Tests; D011292:Premedication; D015742:Propofol / Q000008:administration & dosage; D017409:Sufentanil / Q000008:administration & dosage; D014662:Vasoconstrictor Agents / Q000494:pharmacology; D014665:Vasodilator Agents / Q000494:pharmacology
D018686:Anesthetics, Intravenous; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D017409:Sufentanil; D015742:Propofol