Correlation of bispectral index (BIS) monitoring and end-tidal sevoflurane concentration in a patient with lobar holoprosencephaly.
OBJECTIVE
The bispectral index (BIS) is a parameter derived by electroencephalography (EEG) which provides a direct measurement of the effects of sedatives and anesthetics on the brain and offers guidance on the adequacy of anesthesia. The literature lacks studies on BIS monitoring in pediatric patients with congenital brain disease undergoing general anesthesia.


METHODS
A 13-year-old child weighing 32kg, suffering from lobar holoprosencephaly, underwent surgery in which the bispectral index (BIS) monitoring the depth of anesthesia showed an abnormal response. Detailed analysis of the trends of BIS values in the different observation times demonstrated sudden falls and repetitive values of BIS likely related to repetitive epileptiform electrical activity caused by sevoflurane.


CONCLUSIONS
The BIS is a very useful monitoring tool for assessing the degree of depth of anesthesia and to analyze the electroencephalographic variations of anesthetics. Particular attention should be given to patients with congenital disorders of the central nervous system in which the BIS may give abnormal responses that do not reflect an accurate assessment of the depth of anesthesia.
University Department of Anesthesia and Intensive Care, University Hospital Ospedali Riuniti of Foggia, Italy. Electronic address: dario.galante@tin.it.
Dario
D
Galante
University Department of Anesthesia and Intensive Care, University Hospital Ospedali Riuniti of Foggia, Italy.
Donatella
D
Fortarezza
University Department of Anesthesia and Intensive Care, University Hospital Ospedali Riuniti of Foggia, Italy.
Maria
M
Caggiano
Department of Anesthesia and Intensive Care, Agostino Gemelli Hospital, Catholic University of the Scared Heart, Rome, Italy.
Giovanni
G
de Francisci
Department of Anesthesia and Intensive Care, S. Chiara Hospital, Trento, Italy.
Dino
D
Pedrotti
Department of Anesthesia and Intensive Care, La Timone Children's Hospital, Marseille, France.
Marco
M
Caruselli
D000293:Adolescent; D018685:Anesthetics, Inhalation / Q000493:pharmacokinetics*; D004569:Electroencephalography; D016142:Holoprosencephaly / Q000503:physiopathology*; D006801:Humans; D008738:Methyl Ethers / Q000493:pharmacokinetics*; D008991:Monitoring, Physiologic; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane
Bispectral index; Convulsões; Holoprosencefalia; Holoprosencephaly; Seizures; Sevoflurane; Sevoflurano; Índice bispectral