Quando o índice bispectral (BIS) pode fornecer valores espúrios
When the bispectral index (Bis) can give false results
Leonardo Teixeira Domingues Duarte; Renato Ângelo Saraiva
Resumo
Palavras-chave
Abstract
BACKGROUND AND OBJECTIVES: The bispectral index (BIS) is a multifactorial parameter derived from the electroencephalogram (EEG), which allows monitoring of the hypnotic component of anesthesia. It was obtained from the algorithm based on the analysis of a large number of EEGs from volunteers and patients undergoing sedation and general anesthesia with different anesthetic agents. The use of BIS to monitor the depth of anesthesia reduces the incidence of intraoperative awakening and recall, among other benefits. The objective of this review was to present clinical situations in which the BIS gives false results, either elevated or decreased, due to conditions related to the patient or anesthetic actions unforeseen when the algorithm was elaborated. CONTENTS: The bispectral index can be altered and influenced in different clinical situations in which abnormal EEG patterns are present; the effects of different anesthetics and other drugs not included when the algorithm was elaborated; interference from electrical equipment; as well as peculiarities of the monitor. CONCLUSIONS: Although the BIS algorithm underwent several changes since its first version, the anesthesiologist should be aware of situations that cause false BIS readings to avoid complications, may it be secondary to anesthetic overdose or underdosing, which might cause intraoperative awakening and recall.
Referências
Liu J, Harbhej S, White PF. Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg. 1997;84:185-197.
Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev. 2007.
Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology. 1998;89:980-1002.
Dahaba AA. Different conditions that could result in the bispectral index indicating an incorrect hypnotic state. Anesth Analg. 2005;101:765-773.
Shiraishi T, Uchino H, Sagara T. A comparison of frontal and occipital bispectral index values obtained during neurosurgical procedures. Anesth Analg. 2004;98:1773-1775.
Tonner PH, Wei C, Bein B. Comparison of two bispectral index algorithms in monitoring sedation in postoperative intensive care patients. Crit Care Med. 2005;33:580-584.
Dahaba AA, Mattweber M, Fuchs A. Effect of different stages of neuromuscular block on the bispectral index and the bispectral index-XP under remifentanil propofol anesthesia. Anesth Analg. 2004;99:781-787.
Niedhart DJ, Kaiser HA, Jacobsohn E. Intrapatient reproducibility of the BISxp monitor. Anesthesiology. 2006;104:242-248.
Pilge S, Zanner R, Schneider G. Time delay of index calculation: analysis of cerebral state, bispectral, and narcotrend indices. Anesthesiology. 2006;104:488-494.
Johansen JW, Sebel PS. Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology. 2000;93:1336-1344.
Hemmerling TM, Harvey P. Electrocardiographic electrodes provide the same results as expensive special sensors in the routine monitoring of anesthetic depth. Anesth Analg. 2002;94:369-371.
Vivien B, Di Maria S, Ouattara A. Overestimation of bispectral Index in sedated intensive care unit patients revealed by administration of muscle relaxant. Anesthesiology. 2003;99:9-17.
Baldesi O, Bruder N, Velly L. Spurious bispectral index values due to electromyographic activity. Eur J Anaesthesiol. 2004;21:324-325.
Park KS, Hur EJ, Han KW. Bispectral index does not correlate with observer assessment of alertness and sedation scores during 0.5% bupivacaine epidural anesthesia with nitrous oxide sedation. Anesth Analg. 2006;103:385-389.
Rampil IJ, Kim JS, Lenhardt R. Bispectral EEG index during nitrous oxide administration. Anesthesiology. 1998;89:671-677.
Kearse Jr LA, Rosow C, Zaslavsky A. Bispectral analysis of the electroencephalogram predicts conscious processing of information during propofol sedation and hypnosis. Anesthesiology. 1998;88:25-34.
Coste C, Guignard B, Menigaux C. Nitrous oxide prevents movement during orotracheal intubation without affecting BIS value. Anesth Analg. 2000;91:130-135.
Hans P, Dewandre PY, Brichant JF. Comparative effects of ketamine on Bispectral Index and spectral entropy of the electroencephalogram under sevoflurane anaesthesia. Br J Anaesth. 2005;94:336-340.
Hering W, Geisslinger G, Kamp HD. Changes in the EEG power spectrum after midazolam anaesthesia combined with racemic or S-(+) ketamine. Acta Anaesthesiol Scand. 1994;38:719-723.
Vereecke HE, Struys MM, Mortier EP. A comparison of bispectral index and ARX-derived auditory evoked potential index in measuring the clinical interaction between ketamine and propofol anaesthesia. Anaesthesia. 2003;58:957-961.
Edwards JJ, Soto RG, Thrush DM. Bispectral index scale is higher for halothane than sevoflurane during intraoperative anesthesia. Anesthesiology. 2003;99:1453-1455.
Davidson AJ, Czarnecki C. The bispectral index in children: comparing isoflurane and halothane. Br J Anaesth. 2004;92:14-17.
Edwards JJ, Soto RG, Bedford RF. Bispectral index values are higher during halothane vs. sevoflurane anesthesia in children, but not in infants. Acta Anaesthesiol Scand. 2005;49:1084-1087.
Detsch O, Schneider G, Kochs E. Increasing isoflurane concentration may cause paradoxical increases in the EEG bispectral index in surgical patients. Br J Anaesth. 2000;84:33-37.
Bruhn J, Bouillon TW, Shafer SL. Onset of propofol-induced burst suppression may be correctly detected as deepening of anaesthesia by approximate entropy but not by bispectral index. Br J Anaesth. 2001;87:505-507.
Koitabashi T, Johansen JW, Sebel PS. Remifentanil dose/electroencephalogram bispectral response during combined propofol/regional anesthesia. Anesth Analg. 2002;94:1530-1533.
Struys MM, Vereecke H, Moerman A. Ability of the bispectral index, autoregressive modelling with exogenous input-derived auditory evoked potentials, and predicted propofol concentrations to measure patient responsiveness during anesthesia with propofol and remifentanil. Anesthesiology. 2003;99:802-812.
Lysakowski C, Dumont L, Pellegrini M. Effects of fentanyl, alfentanil, remifentanil and sufentanil on loss of consciousness and bispectral index during propofol induction of anaes- thesia. Br J Anaesth. 2001;86:523-527.
Barr G, Anderson RE, Owall A. Effects on the bispectral index during medium-high dose fentanyl induction with or without propofol supplement. Acta Anaesthesiol Scand. 2000;44:807-811.
Barr G, Anderson RE, Samuelsson S. Fentanyl and midazolam anaesthesia for coronary bypass surgery: a clinical study of bispectral electroencephalogram analysis, drug concentrations and recall. Br J Anaesth. 2000;84:749-752.
Matthews R. Isoproterenol-induced elevated bispectral indexes while undergoing radiofrequency ablation: a case report. AANA J. 2006;74:193-195.
Matisoff AJ, Panni MK. Methylene blue treatment for methemoglobinemia and subsequent dramatic bispectral index reduction. Anesthesiology. 2006;105:228.
Gallagher JD. Pacer-induced artifact in the bispectral index during cardiac surgery. Anesthesiology. 1999;90:636.
Hemmerling TM, Fortier JD. Falsely increased bispectral index values in a series of patients undergoing cardiac surgery using forced-air-warming therapy of the head. Anesth Analg. 2002;95:322-323.
Hemmerling TM, Migneault B. Falsely increased bispectral index during endoscopic shoulder surgery attributed to interferences with the endoscopic shaver device. Anesth Analg. 2002;95:1678-1679.
Hemmerling TM, Desrosiers M. Interference of electromagnetic operating systems in otorhinolaryngology surgery with bispectral index monitoring. Anesth Analg. 2003;96:1698-1699.
Mychaskiw G, Horowitz M, Sachdev V. Explicit intraoperative recall at a Bispectral Index of 47. Anesth Analg. 2001;92:808-809.
Morimoto Y, Matsumoto A, Koizumi Y. Changes in the bispectral index during intraabdominal irrigation in patients anesthetized with nitrous oxide and sevoflurane. Anesth Analg. 2005;100:1370-1374.
Schnider TW, Luginbuehl M, Petersen-Felix S. Unreasonably low bispectral index values in a volunteer with genetically determined low-voltage electroencephalographic signal. Anesthesiology. 1998;89:1607-1608.
Muncaster ARG, Sleigh JW, Williams M. Changes in consciousness, conceptual memory, and quantitative electroencephalographical measures during recovery from sevoflurane- and remifentanil-based anesthesia. Anesth Analg. 2003;96:720-725.
Hagihira S, Okitsu K, Kawaguchi M. Unusually low bispectral index values during emergence from anesthesia. Anesth Analg. 2004;98:1036-1038.
Gunawardane PO, Murphy PA, Sleigh JW. Bispectral index monitoring during electroconvulsive therapy. Anesth Analg. 2002;88:184-187.
Deogaonkar A, Gupta R, DeGeorgia M. Bispectral index monitoring correlates with sedation scales in brain-injured patients. Crit Care Med. 2004;32:2403-2406.
Renna M, Handy J, Shah A. Low baseline bispectral index of the electroencephalogram in patients with dementia. Anesth Analg. 2003;96:1380-1385.
Choudhry DK, Brenn BR. Bispectral index monitoring: a comparison between normal children and children with quadriplegic cerebral palsy. Anesth Analg. 2002;95:1582-11585.
Pandit JJ, Schmelzle-Lubiecki B, Goodwin M. Bispectral index-guided management of anaesthesia in permanent vegetative state. Anaesthesia. 2002;57:1190-1194.
Myles PS, Cairo S. Artifact in bispectral index in a patient with severe ischemic brain injury. Anesth Analg. 2004;98:706-707.
Azim N, Wang CY. The use of bispectral index during a cardiopulmonary arrest: a potential predictor of cerebral perfusion. Anaesthesia. 2004;59:610-612.
Engl MR. The changes in bispectral index during a hypovolemic cardiac arrest. Anesthesiology. 1999;91:1947-1948.
Honan DM, Breen PJ, Boylan JF. Decreasing in bispectral index preceding intraoperative hemodynamic crisis: evidence of acute alteration of propofol pharmacokinetics. Anesthesiology. 2002;97:1303-1305.
Merat S, Levecque JP, Le Gulluche Y. BIS monitoring may allow the detection of severe cerebral ischemia. Can J Anaesth. 2001;48:1066-1069.
Mathew JP, Weatherwax KJ, East CJ. Bispectral analysis during cardiopulmonary bypass: the effect of hypothermia on the hypnotic state. J Clin Anesth. 2001;13:301-305.
Tribl G, Howorka K, Heger G. EEG topography during insulin-induced hypoglycemia in patients with insulin-dependent diabetes mellitus. Eur Neurol. 1996;36:303-309.
Vivien B, Langeron O, Riou B. Increase in bispectral index (BIS) while correcting a severe hypoglycemia. Anesth Analg. 2002;95:1824-1825.
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