Interest of BIS monitoring to guide propofol infusion during the anhepatic phase of orthotopic liver transplantation

Objective. - The anhepatic phase of orthotopic liver transplantation (OLT) is associated with significant changes in pharmacokinetics. The aim of this study was to compare the influence of this phase on propofol target concentrations during BIS guided target controlled infusion (TCI). Study design. - Prospective study. Patients and methods. - Eight patients aged 25 to 65 years, Child-Pugh status A-B scheduled for OLT were prospectively included. Anesthesia was performed using TCI of propofol (Diprifusor (R), Marsh pharmacokinetic model), sufentanil and cisatracurium. Propofol target concentration was adjusted to maintain BIS values between 40 and 50. Results. - To maintain stable BIS values, propofol target concentrations should be decreased during the anhepatic phase versus the dissection one (2.0 mu g/ml +/- 0.8 versus 3.0 mu g/ml +/- 0.9, p < 0.0001). Conclusion. - BIS could be useful to titrate propofol infusion during the anhepatic phase of OLT. (C) 2008 Elsevier Masson SAS. All rights reserved.