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The effect of epidural bupivacaine on maintenance requirements of sevoflurane evaluated by bispectral index in children

Published online by Cambridge University Press:  01 March 2006

F. Reinoso-Barbero ,
E. Martínez-García ,
M. C. Hernández-Gancedo  and
A. M. Simon
F. Reinoso-Barbero
Affiliation:
Universidad Autónoma de Madrid, Medical School, Department of Surgery, Pamplona, Spain
E. Martínez-García
Affiliation:
Hospital Universitario ‘La Paz’, Department of Anesthesiology, Madrid, Pamplona, Spain
M. C. Hernández-Gancedo
Affiliation:
Hospital Universitario ‘La Paz’, Department of Anesthesiology, Madrid, Pamplona, Spain
A. M. Simon
Affiliation:
Clínica Universitaria de Navarra, Department of Anesthesiology, Pamplona, Spain
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Extract

Summary

Background and objective: Combined (local and general) anaesthesia or Balanced (intravenous analgesics and inhalational hypnotics) anaesthesia are commonly used in paediatrics. The authors have investigated the influence of both types of anaesthesia on the requirements of sevoflurane to maintain an adequate level of hypnosis as measured by Bispectral index (at around 50) monitoring in paediatric orthopaedic patients. Methods: Twenty-six orthopaedic surgery patients aged 2–15 yr were randomized to receive, during general sevoflurane anaesthesia, 5 μg kg−1 of intravenous fentanyl (Balanced anaesthesia group) or 1 mL kg−1 of caudal-epidural bupivacaine 0.25% (Combined anaesthesia group). The end-tidal sevoflurane concentration was adjusted every 5 min in order to maintain Bispectral index values at around 50. Results: Patients showed very similar Bispectral index values (P > 0.05) in both the Combined and the Balanced groups before anaesthesia (96.7 ± 2.7 vs. 96.9 ± 1.8), after induction (48.5 ± 2.9 vs. 49.8 ± 3.6) and after administration of analgesia (50.9 ± 3.8 vs. 50.3 ± 4.3). The sevoflurane end-tidal concentration requirements were similar in both the Combined and Balanced groups before administration of analgesia (2.1 ± 0.2 vs. 2.1 ± 0.4, P = 0.9415), but lower end-tidal concentrations were required by the Combined group than by the Balanced group (0.81 ± 0.4 vs. 1.5 ± 0.5, P < 0.0001) in the first 20 min after administration of analgesia. Conclusion: Combined anaesthesia with epidural bupivacaine maintains the same Bispectral index values as Balanced anaesthesia during orthopaedic surgery in children without fentanyl and with a lower sevoflurane requirement.

Keywords

ANALGESICS OPIOID, fentanylANAESTHETICS INHALATIONAL, sevofluraneANAESTHESIA GENERAL, bispectral index monitoringCHILDRENEPIDURAL ANALGESIA, bupivacaineSURGERY, ORTHOPAEDICELECTROENCEPHALOGRAPHY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 6 , June 2006 , pp. 460 - 464
Copyright
© 2006 European Society of Anaesthesiology

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