Bispectral index (BIS) monitoring during propofol-induced sedation and anaesthesia

One may have to use a monitor of cortical suppression to maintain the optimal level of sedation and hypnosis. The bispectral index (BIS), a processed EEG parameter, which incorporates coupling along with the frequency and amplitude of EEG waveforms, has been proposed as a measure of the pharmacodynamic anaesthetic effect on the central nervous system. The numerical value of BIS varies from 0 to 100 (no cerebral activity to fully awake patient). In order to achievethe desired level of propofol sedation or hypnosis, a target concentration of propofol at the effect site or in the blood must be delivered. Alternately, one may use BIS monitoring to monitor hypnosis or sedation levels or to reflect propofol concentrations in the blood. Significant correlations between plasma propofol concentrations and BIS values (r=0.68-0.78) have been reported by many investigators. During propofol-induced sedation, BIS values may be maintained above 75 to prevent airway obstruction and hypoxia. During propofol intravenous anaesthesia, BIS values from 40 to 60 have been proposed to maintain the desired level of hypnosis, with values below 50 associated with an insignificant probability of recall. However, the major limitation of the BIS monitor (monitor of hypnosis) relates to the fact that balanced anaesthesia comprises hypnosis, areflexia and analgesia and requires the administration of hypnotic agents, muscle relaxants and analgesics to achieve the desired clinical effects. Therefore, besides using the BIS value guidelines, one may also consider the haemodynamic, autonomic and somatic responses of the patient, the anaesthetic technique and the surgical interventions before deriving definite conclusions about the overall anaesthetic state of the patient.