title: The effect of epidural bupivacaine on maintenance requirements of sevoflurane evaluated by bispectral index in children.
abstract: OBJECTIVE
  Combined (local and general) anaesthesia or Balanced (intravenous analgesics and inhalational hypnotics) anaesthesia are commonly used in paediatrics. The authors have investigated the influence of both types of anaesthesia on the requirements of sevoflurane to maintain an adequate level of hypnosis as measured by Bispectral index (at around 50) monitoring in paediatric orthopaedic patients.
  
  
  METHODS
  Twenty-six orthopaedic surgery patients aged 2-15 yr were randomized to receive, during general sevoflurane anaesthesia, 5 microg kg-1 of intravenous fentanyl (Balanced anaesthesia group) or 1 mL kg-1 of caudal-epidural bupivacaine 0.25% (Combined anaesthesia group). The end-tidal sevoflurane concentration was adjusted every 5 min in order to maintain Bispectral index values at around 50.
  
  
  RESULTS
  Patients showed very similar Bispectral index values (P > 0.05) in both the Combined and the Balanced groups before anaesthesia (96.7 +/- 2.7 vs. 96.9 +/- 1.8), after induction (48.5 +/- 2.9 vs. 49.8 +/- 3.6) and after administration of analgesia (50.9 +/- 3.8 vs. 50.3 +/- 4.3). The sevoflurane end-tidal concentration requirements were similar in both the Combined and Balanced groups before administration of analgesia (2.1 +/- 0.2 vs. 2.1 +/- 0.4, P = 0.9415), but lower end-tidal concentrations were required by the Combined group than by the Balanced group (0.81 +/- 0.4 vs. 1.5 +/- 0.5, P < 0.0001) in the first 20 min after administration of analgesia.
  
  
  CONCLUSIONS
  Combined anaesthesia with epidural bupivacaine maintains the same Bispectral index values as Balanced anaesthesia during orthopaedic surgery in children without fentanyl and with a lower sevoflurane requirement.
authors.affiliation: Department of Surgery, Medical School, Universidad Autónoma de Madrid, Pamplona, Spain. franreinoso@terra.es
authors.forename: F
authors.initials: F
authors.lastname: Reinoso-Barbero
authors.forename: E
authors.initials: E
authors.lastname: Martínez-García
authors.forename: M C
authors.initials: MC
authors.lastname: Hernández-Gancedo
authors.forename: A M
authors.initials: AM
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D000763:Anesthesia, Caudal; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods; D019162:Anesthetics, Combined / Q000008:administration & dosage; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000494:pharmacology*; D002045:Bupivacaine / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004357:Drug Synergism; D004569:Electroencephalography / Q000187:drug effects / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D019637:Orthopedic Procedures; D011446:Prospective Studies; D000077149:Sevoflurane
chemical_list: D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008738:Methyl Ethers; D000077149:Sevoflurane; D005283:Fentanyl; D002045:Bupivacaine