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Elevated BIS and E ntropy values after sugammadex or neostigmine: an electroencephalographic or electromyographic phenomenon?
Author(s) -
AHO A. J.,
KAMATA K.,
YLIHANKALA A.,
LYYTIKÄINEN L.P.,
KULKAS A.,
JÄNTTI V.
Publication year - 2012
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2011.02647.x
Subject(s) - sugammadex , rocuronium , medicine , remifentanil , propofol , neostigmine , anesthesia , bispectral index , muscle relaxation , neuromuscular blockade , electromyography , physical medicine and rehabilitation
Background Sugammadex is designed to antagonize neuromuscular blockade ( NMB ) induced by rocuronium or vecuronium. In clinical practice, we have noticed a rise in the numerical values of bispectral index ( BIS ) and E ntropy, two electroencephalogram ( EEG ) – based depth of anesthesia monitors, during the reversal of the NMB with sugammadex. The aim of this prospective, randomized, double‐blind study was to test this impression and to compare the effects of sugammadex and neostigmine on the BIS and E ntropy values during the reversal of the NMB . Methods Thirty patients undergoing gynecological operations were studied. Patients were anesthetized with target‐controlled infusions of propofol and remifentanil, and rocuronium was used to induce NMB . After operation, during light propofol‐remifentanil anesthesia, NMB was antagonized with sugammadex or neostigmine. During the following 5 min, the numerical values of BIS , BIS electromyographic ( BIS EMG ) and E ntropy were recorded on a laptop computer, as well as the biosignal recorded by the E ntropy strip. The E ntropy biosignal was studied off‐line both in time and frequency domain to see if NMB reversal causes changes in EEG . Results In some patients, administration of sugammadex or neostigmine caused a significant rise in the numerical values of BIS , BIS EMG and E ntropy. This phenomenon was most likely caused by increased electromyographic ( EMG ) activity. The administration of sugammadex or neostigmine appeared to have only minimal effect on EEG . Conclusion The EMG contamination of EEG causes BIS and E ntropy values to rise during reversal of rocuronium‐induced NMB in light propofol‐remifentanil anesthesia.