Bispectral index analysis for the quality of recovery in patients undergoing elective laparoscopic surgeries: a comparative study

Abstract

ABSTRACT BISPECTRAL INDEX ANALYSIS FOR THE QUALITY OF RECOVERY IN PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC SURGERIES: A COMPARATIVE STUDY INTRODUCTION: Bis is a processed EEG in which electrodes are placed on the forehead, and BIS scores are continually presented, indicating the state of awareness. AIM AND OBJECTIVES OF THE STUDY: A. To compare the time of recovery in post-operative period with and without the use of BIS (Bispectral Index). B. To compare the quality of recovery in the post-operative period with and without the use of BIS (Bispectral Index). MATERIALS & METHOD: Seventy-two patients of age group 18-60 years belonging to ASA I-II undergoing laparoscopic surgeries under general anesthesia were recruited in this prospective comparative study. Thirty-six patients in the BIS group were compared to 36 controls who received BIS monitoring in addition to standard monitoring. Pre-anesthetic evaluations were performed on all patients, and standard NPO protocols were observed. Routine anaesthetic drills are performed upon arrival in the operating room, and the patient's baseline measures such as blood pressure, heart rate, ECG, and pulse oximetry are documented. Intravenous access is established, and an IV infusion of Ringer lactate is started. Using a frontal–temporal montage, a BIS electrodes strip was placed on the forehead and temples. Patients were premedicated Intravenously (I.V.) with Inj. Midazolam 0.08-0.1 mg/kg, Inj. Glycopyrrolate 0.008-0.15 mg/kg, Inj. Ondansetron 0.15mg/kg 30 min before the procedure. Fentanyl 2-4 mcg/kg, I.V. VI was used as an analgesic. IV Propofol 2 mg/kg was used to induce anaesthesia in the patients. To enable tracheal intubation with the proper size ETT, IV succinyl scholine 1-1.5 mg/kg was administered as a muscle relaxant. For anaesthetic maintenance, nitrous oxide (33 %:66 %), isoflurane was used, and vecuronium 0.08-0.12 mg/kg was administered for muscle relaxation. BIS score was displayed on the monitor. Beginning before the anaesthetic induction and continuing until patients were awake and responsive to vocal orders after extubation at the end of the surgery, the EEG was constantly monitored. In both groups, depth of anesthesia was maintained by titrating Isoflurane by keeping BIS score between 40-60 in the BIS group. In contrast, in the Control group, it was held by titrating isoflurane according to heart rate and mean arterial pressure. The groups were compared as regards with recovery time at the end of anesthesia based on time for eye-opening and responds to verbal commands. Quality of recovery is assessed by orientation to time, place and person, swallow reflex, and cough reflex.