Zmiany indeksu bispektralnego w znieczuleniu pojedynczš dawkš tiopentalu lub propofolu do testów kardiowerterów-defibrylatorów

*Małgorzata Nawrocka¹, Magdalena A. Wujtewicz¹, Barbara Kwiecińska¹, Anna Dylczyk-Sommer¹, Radosław Owczuk¹, Maciej Kempa²

Summary
Background.Implanted cardioverter-defibrillators have proven to be very effective in interrupting episodes of ventricular fibrillation and ventricular tachyarrhythmia. Every implanted device needs to be tested to assess the appropriate defibrillation threshold. Testing involves initiation of cardiac arrhythmias and subsequent adjustment of the device. Because of unpleasant sensations associated with testing, most patients need to be anaesthetized for the procedure. Some of these patients present with various degrees of cardiac failure, therefore the dose of anaesthetic agent should be as low as possible. To determine a suitable dose, that would secure loss of consciousness with minimal cardiovascular depression, we used bispectral index analysis.
Methods. Fifty patients were allocated to two groups to receive 1.5 mg kg^-1 propofol (27) or 5 mg kg^-1 thiopentone (23) for sedation before defibrillator testing. The following parameters were noted: baseline, minimal and recovery BSI readings, time to loss of eyelash reflex, time from injection to minimal BIS reading, time from injection to verbal contact and time from injection to return of the baseline BIS readings. Student´s and Mann-Whitney tests were used for statistical analysis.
Results. The time to loss of the eyelash reflex was similar, as were the recovery BIS values. In the thiopentone group, the minimal BIS values were significantly lower, and the time from injection to minimal BIS value was also shorter. The time to recovery of the baseline BIS value was significantly longer in the thiopentone group. There were no episodes of serious cardiovascular compromise.
Conclusion. We conclude that propofol should be regarded as the optimal drug for anaesthesia in cardioverter-defibrillator testing, replacing the traditionally used etomidate.

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