Different Propofol–Remifentanil or Sevoflurane–Remifentanil Bispectral Index Levels for Electrocorticographic Spike Identification during Epilepsy Surgery

• Published in: Anesthesiology (Philadelphia) 2013-09, Vol.119 (3), p.582-592
• Main Authors: Dahaba, Ashraf A., Yin, Jian, Xiao, Zhaoyang, Su, Jing, Bornemann, Helmar, Dong, Hailong, Xiong, Lize
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics - administration & dosage; Biological and medical sciences; Electroencephalography - drug effects; Epilepsy; Epilepsy - physiopathology; Epilepsy - surgery; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Male; Medical sciences; Methyl Ethers - administration & dosage; Methyl Ethers - pharmacology; Nervous system (semeiology, syndromes); Neurology; Piperidines - administration & dosage; Piperidines - pharmacology; Propofol - administration & dosage; Propofol - pharmacology
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0b013e3182976036

BACKGROUND:Medical therapy, the cornerstone of managing epilepsy, still fails a substantial portion of patients. Little information is available regarding the potential impact of different bispectral index (BIS) levels on electrocorticographic spike identification for surgical epileptic foci resection. METHODS:Twenty-two intractable epilepsy subjects were randomly allocated to the propofol–remifentanil or sevoflurane–remifentanil groups, and were further randomized to four BIS85 (BIS 71–85), BIS70 (BIS 56–70), BIS55 (BIS 41–55), and BIS40 (BIS ≤40) sequence order. RESULTS:Two-way ANOVA revealed no differences between groups in spike frequency (P = 0.720), spike amplitude (P = 0.647), or number of spiking leads (P = 0.653). In the propofol and sevoflurane groups, decreasing BIS levels increased mean ± SD spike/min frequency (P < 0.001 and P < 0.001) at BIS85 (10 ± 12 and 10 ± 8), BIS70 (19 ± 17 and 17 ± 15), BIS55 (22 ± 17 and 18 ± 8), and BIS40 (25 ± 15 and 23 ± 17). Furthermore, in the propofol and sevoflurane groups, decreasing BIS levels increased spike microvolt amplitude (P = 0.006 and P = 0.009) at BIS85 (1,100 ± 400 and 750 ± 400), BIS70 (1,200 ± 460 and 850 ± 490), BIS55 (1,300 ± 560 and 940 ± 700), and BIS40 (1,400 ± 570 and 1,300 ± 700). Whereas, in the propofol and sevoflurane groups, there was no difference in the location or number of spiking leads (P = 0.057 and P = 0.109) at the four BIS levels. Compared with BIS85, spike frequency in the propofol and sevoflurane groups increased 100 and 170% at BIS70, 116 and 180% at BIS55, and 132 and 230% at BIS40. Compared with BIS85, spike amplitude increased 108 and 113% at BIS70, 121 and 125% at BIS55, and 128 and 170% at BIS40. CONCLUSION:Decreasing BIS levels in the propofol and sevoflurane groups enhanced epileptogenic spike frequency and amplitude with the same location and number of spiking leads.