Is the Bispectral Index Useful in Predicting Fast-Track Eligibility After Ambulatory Anesthesia with Propofol and Desflurane?

This study was designed to test the hypothesis that outpatients with higher electroencephalographic (EEG) Bispectral Index (BIS) values at the end of anesthesia achieve a modified Aldrete score of 10 and satisfy fast-track eligibility criteria more rapidly after ambulatory surgery. Sixty consenting women undergoing laparoscopic tubal ligation procedures were studied. After premedication with midazolam 2 mg IV, anesthesia was induced with propofol 2 mg/kg IV, fentanyl 1.5 [micro sign]g/kg IV, and succinylcholine 1 mg/kg IV and was initially maintained with either desflurane 4% (n = 31) or a propofol infusion 100 [micro sign]g [center dot] kg-1 [center dot] min-1 (n = 29), in combination with nitrous oxide 65% in oxygen. Subsequently, the inspired desflurane concentrations (2%-6%) and propofol infusion rates (50-150 [micro sign]g [center dot] kg-1 [center dot] min-1 were varied to maintain a clinically acceptable depth of anesthesia. The average BIS value during the 3-min interval immediately before the discontinuation of the maintenance anesthetics was recorded. Emergence times and modified Aldrete scores were assessed from the end of anesthesia until patients were considered fast-track-eligible. The BIS values at the end of anesthesia were significantly correlated with the time to reach fast-track eligibility in both the desflurane (r = -0.68) and propofol (r = -0.76) groups. We concluded that the EEG-BIS value at the end of anesthesia is useful in predicting fast-track eligibility after laparoscopic tubal ligation procedures with either a desflurane- or propofol-based anesthetic technique. Implications: In outpatients receiving either desflurane and propofol anesthesia for laparoscopic tubal ligation surgery, the times to achieve criteria for bypassing the recovery room (i.e., fast-tracking) correlated with the electroencephalo-graphic-Bispectral Index values at the end of anesthesia. (Anesth Analg 1998;87:1245-8)

[1]  P. White,et al.  Propofol‐Nitrous Oxide Versus Thiopental‐isoflurane‐nitrous Oxide for General Anesthesia , 1988, Anesthesiology.

[2]  F. Chung,et al.  A post-anesthetic discharge scoring system for home readiness after ambulatory surgery. , 1995, Journal of clinical anesthesia.

[3]  Peter S. Sebel,et al.  Bispectral Index Monitoring Allows Faster Emergence and Improved Recovery from Propofol, Alfentanil, and Nitrous Oxide Anesthesia , 1997 .

[4]  J A Aldrete,et al.  The post-anesthesia recovery score revisited. , 1995, Journal of clinical anesthesia.

[5]  D. Lubarsky.  Fast track in the postanesthesia care unit: unlimited possibilities? , 1996, Journal of clinical anesthesia.

[6]  Criteria for fast-tracking outpatients after ambulatory surgery. , 1999 .

[7]  P. White,et al.  Recovery profile after desflurane-nitrous oxide versus isoflurane-nitrous oxide in outpatients. , 1991, Anesthesiology.

[8]  P. White.  Criteria for fast-tracking outpatients after ambulatory surgery. , 1999, Journal of clinical anesthesia.

[9]  P. Sebel,et al.  Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. , 1997, Anesthesiology.

[10]  P. White,et al.  Sevoflurane Versus Desflurane for Outpatient Anesthesia: A Comparison of Maintenance and Recovery Profiles , 1995, Anesthesia and analgesia.

[11]  P. White,et al.  Fast-Track Eligibility After Ambulatory Anesthesia: A Comparison of Desflurane, Sevoflurane, and Propofol , 1998, Anesthesia and analgesia.

[12]  Jin Liu,et al.  Electroencephalographic Bispectral Index Correlates with Intraoperative Recall and Depth of Propofol-Induced Sedation , 1997, Anesthesia and analgesia.

[13]  Paul F. White,et al.  Titration of Volatile Anesthetics Using Bispectral Index Facilitates Recovery after Ambulatory Anesthesia , 1997, Anesthesiology.

[14]  N. T. Smith,et al.  A Multicenter Study of Bispectral Electroencephalogram Analysis for Monitoring Anesthetic Effect , 1997, Anesthesia and analgesia.