ZEYNEP TOSUN, Aliye ESMAOĞLU, Adem BOYACI

Genel anestezi uygulanan elektif sezaryen operasyonlarında bispektral indeks, spektral edge frekansı ve pupil çapı ilişkisi

Çalışmanın amacı, genel anestezi derinliğinin değerlendirilmesinde geleneksel olarak kullanılan pupil çapı ile daha objektif ve güncel olan Bispektral lndeks (BİS)' in korelasyonunu değerlendirmektir. Etik komite izni alınmış, elektif sezaryen planlanan, ASA l grubundan 40 hasta rutin monitörizasyona ek olarak, BIS ile monitörize edildiler. Anestezi indüksiyonu; 4 mg $kg^{-1}$ tiyopental ve 1-1.5 mg $kg^{-1}$ süksinil kolin ile, idamesi; %1 sevofluran ile sağlandı. BİS, Spectral Edge Frequency (SEF), pupil çapı ve hemodinamik ölçümler; indüksiyon öncesi, sonrası, entübasyon sonrası, umblikal kord klempi (UKK) sonrası, bundan sonraki her 10 dakikada, ekstübasyon öncesi ve sonrasında kaydedildi. BİS-pupil çapı arasında; sadece UKK sonrasında ve UKK'den 20 dk sonraki değerlerde anlamlı korelasyon bulundu. SEF-pupil çapı arasında ise UKK'den sonraki 20. ve 30. dk'larda anlamlı bir korelasyon bulundu (p

Anahtar Kelimeler:

Süksinilkolin, Anestezi, genel, Tiyopental, Sezaryen

The relation between bispectral index, spectral edge frequency and pupil diameter in cesarean operation under general anesthesia

The aim of this study is to evaluate the correlation between bispectral index (BIS) and spectral edge frequency (SEF) more objective and actual with pupil diameter used to evaluate anesthetic depth conventionally. Fourty ASA I elective cesarean section candidates were monitorized with BIS in addition to routine monitorization. Induction of anesthesia was maintained with 4 mg $kg^{-1}$ thiopental and 1-1.5 mg $kg^{-1}$ sch and sevoflurane was used for the maintenance. BIS, SEF, pupil diameter and hemodynamic measurements were recorded before induction, after intubation, following umblical chord clamp (UCC) and every 10 min after this and lastly just before and after extubation. There was a significant correlation between BIS and pupil diameter following UCC and 20 min after UCC( p< 0.05, r= 0.323, 0.406). A significant correlation was also found berween SEF and pupil diameter at 20. and 30. min after UCC (p<0.05, r= 0.529, 0.417)). Hemodynamic parameters did not show a significant correlation with any of SEF, BIS and pupil diameter. We think that these unsustained correlations may be accidental findings. We concluded that, there is no important correlation between pupil diameter and BIS and SEF. Additionally hemodynamic parameters are not correlated with any of them.

Keywords:

Succinylcholine, Anesthesia, General, Thiopental, Cesarean Section,

PDF

___

1. Sitzwohl C, Burger HJ, Kettner SC et al. Bispectral index predicts anesthetic depth better than pupillary responses or anesthesia residents. Anesthesiology 1997: 87: A435.
2. Sitzwohl C, Seibt FA, Steininger S et al. Bispectral Index Predicts Anesthetic Depth Better than Pupillary Responses to Light and Anesthesiology Residents at Different Levels of Training. Anesthesiology 1998; 89: 3A; A927.
3. Liu J, Singh H, Wu G et al. Use of the EEG bispectral index to predict awakening from general anesthesia. Anesth Analg 1994; 78: S254.
4. Glass PSA, Johansen J: The bispectral index monitor. Surgical Services Management 1998: 4; 10: 50-52.
5. Aspect Medical Systems, Inc. 2 Vision Drive Natick, MA 01760-2059. Technology Overview: Bispectral Index. Aspect Medical Systems 1997: 1-8.
6. Leslie K, Sessler DI, Smith WD et al. Prediction of movement during propofol/nitrous oxide anesthesia. Anesthesiology 1996; 84: 52-63.
7. Larson MD, Sessler Di, McGuire J et al. Isoflurane, but not mild hypothermia, depresses the human pupillary light reflex. Anesthesiology 1991; 75: 62-67.
8. Rosow C, Manberg PJ. Bispectral index Monitoring. Anesth Clin North Am 1998; 2:89-107.
9. Sleigh JW, Andrzejowski J, Steyn-Ross A et al. The Bispectral Index : Ameasure of depth of sleep? Anesth Analg 1999; 88:659-661.
10. Schwender D, Daunderer M, Mulzar S et al. Spactral edge frequency of the electroencephalogram to monitor "depth" of anaesthesia. Br J Anaesth 1996; 77: 179-84.
11. Song D, Joshi GP, White PF. Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia. Anesthesiology 1997: 87; 842-48.
12. Colvard M: Preoperative measurement of scotopic pupil dilation using an office pupillometer. J Cataract Refract Surg 1998: Dec, 24; 12: 1594-7
13. Sebel PS, Bowles S, Saini V et al. Accuracy of EEG in predicting movement at incision during isoflurane anesthesia. Anesthesiology 1991: 75; A446.
14. Plaud B, Billard V, Debaene B. BIS predict inadequate level of anesthesia during sevoflurane administration. 1997: 87; A326.
15. Vernon J, Bowles S, Sebel PS et al. EEG Bispectrum predicts movement at incision during isoflurane or propofol anesthesia. Anesthesiology 1992: 77; A502.
16. Greenwald S, Chiang HH, Devlin P et al. The bispectral index(BIS 2.0) as a hypnosis measure 1994: 81; A477.
17. Katoh T, Suzuki A, Ikeda K. Electroencephalographic derivatives as a tool for predicting the depth of sedation and anesthesia induced by sevoflurane. Anesthesiology 1998: 88; 642- 50.
18. Kissin I. Depth of anesthesia and bispectral index monitoring. Anesth Analg 2000: 90; 1114-7.
19. Tatekawa S, Asada A, Nishikawa K et al. Comparison of sevoflurane with isoflurane anesthesia for use in elective cesarean section. Anesthesiology 1993: 79; A1018.
20. Sharma SK, Gambling DR, White PF et al. A comparison of sevoflurane/ N2O isoflurane/N2O and spinal anesthesia for cesarean birth: Neonatal outcome and neurobehavioural adaptation. Anesthesiology 1994: 81;A1129.
21. Lubke GH, Kerssens C, Gershon RY et al. Bispectral index(BIS) in relation to memory function during emergency cesarean sections. Anesthesiology 1999: 91; A48.
22. Glass PS, Bloom M, Kearse L et al. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane and alfentanil in healthy volunteers. Anesthesiology 1997: 86; 836-47.
23. Flaishon R, Windsor A, Sigl J et al. Recovery of consciousness after thiopental or propofol: Bispectral EEG(BIS) and the isolated forearm technique. Anesthesiology 1997: 86; 613-19.
24. Iselin- Chaves IA, Flaishon R, Sebel PS et al. The effect of interaction of propofol and alfentanil on recall, loss of consciousness and the bispectral index. Anesth Analg 1998: 87; 949- 55.
25. Gaitini L, Vaida S, Collins G et al. Awareness detection during caesarean section under general anaesthesia using EEG spectrum analysis. Can J Anaesth 1995: 43: 377- 81.
26. Liu J Singh H, White PF: Electroencephalogram bispectral analysis predicts the depth of midazolam- induced sedation. Anesthesiology 1996: 84; 64-9.
27. Dwyer RC, Rampil IJ Eğer E II et al. The electroencephalogram does not predict depth of isoflurane anesthesia. Anesthesiology 1994: 81; 403-9.
28. Drummond JC, Brann CA, Perkins DE et al. A comparison of median frequency, spectral edge frequency, a frequency band power ratio, total power and dominance shift in the determination of depth of anesthesia. Acta Anaesthesiol Scand 1991: 35; 693-9.
29. Chen CL, Liu CC, Chen TL et al. Recovery from propofol anesthesia: A quantitative electroencephalographic analysis. Acta Anesthesiol Sin 1994: 32; 77-82.