Thiopental-induced burst suppression measured by the bispectral index is extended
during propofol administration compared with sevoflurane.
Author(s): Yoon JR, Kim YS, Kim TK.
Affiliation(s): Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic
University of Korea, Seoul, South Korea.
Publication date & source: 2012, J Neurosurg Anesthesiol. , 24(2):146-51
BACKGROUND: Thiopental is used to suppress cerebral metabolism during temporary
clip ligation of the cerebral arteries. Electroencephalogram (EEG) can measure
intraoperative burst suppression as evidence of cerebral metabolic suppression,
but EEG is not always available during clip ligation. This study was conducted to
compare the effect of propofol-based total intravenous anesthesia (TIVA) with
sevoflurane-based inhalational anesthesia on thiopental-induced burst suppression
during aneurysm surgery. The effect of thiopental was measured by burst
suppression ratio (BSR) using the bispectral index (BIS) monitor.
METHODS: Forty-six patients who underwent temporary clipping during aneurysm
surgery were randomized into 2 groups. The inhalation group (n=21) received
sevoflurane-N(2)O anesthesia and the TIVA group (n=25) received
propofol-remifenatanil-N(2)O anesthesia. The anesthesia level maintained a BIS
value between 40 and 55. Pharmacological burst suppression was induced with bolus
administration of thiopental (5 mg/kg) before temporary clipping. The BIS number,
BSR values, the onset time and duration of BSR, and hemodynamic variables were
recorded every minute in both groups.
RESULTS: There were no significant differences between groups in the onset time
of burst suppression (P=0.394) and BIS changes (P=0.878). However, statistically
significant longer duration (P<0.001) and significantly higher degree of burst
suppression (P=0.006) were observed in the TIVA group compared with the
inhalation group.
CONCLUSIONS: Our results suggest that at equivalent BIS values TIVA with propofol
anesthesia provides longer duration and greater cerebral metabolic suppression
compared with sevoflurane-N(2)O inhalation anesthesia. BIS may be an acceptable
alternative to standard EEG monitoring when assessing burst suppression during
temporary clipping.
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