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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2022; 09(03): 149-154
DOI: 10.1055/s-0042-1756430
Original Article

Supralabial Site: An Alternative Site for Bispectral Index Monitoring: A Cross-sectional Study

Jitendra K. Dubey
1   Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
,
Nitesh Goel 
1   Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
,
Rajiv Chawla
1   Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
,
Manish Gupta
1   Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
,
Manoj Bhardwaj
1   Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
› Author Affiliations Funding This research was funded by Rajiv Gandhi Cancer Institute and Research Centre, New Delhi.
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Abstract

Background Bi-spectral index (BIS) has been traditionally used to monitor the depth of anesthesia, with the forehead being the usual site for electrode placement. When the manufacturer-recommended site is itself an operative field or the placement interferes with the surgery, the search for an alternative position of electrode placement is warranted. In our endeavor to do so, we conducted this study to compare BIS scores derived from frontal and supralabial electrode placement.

Methods A cross-sectional study was conducted on a group of 50 patients using two BIS Quatro sensors attached to the frontal and supralabial regions of each patient and connected to two different sets of monitors. BIS values, electromyography (EMG) values, and signal quality index (SQI) were noted from both sites every 15 min during the maintenance phase of anesthesia. Collected data were analyzed using the Bland–Altman analysis.

Results Data analysis of BIS values showed negative bias at most time points with a minimum negative bias of 0.2 with a limit of agreement of −3.67/3.27 and a maximum negative bias of 1.14 with a limit of agreement of −7.61/5.33. The overall 95% limit of agreement for pooled BIS data ranged from −6.63 to 6.1.

Conclusion BIS sensor placement at the supralabial site can be used as an alternative to the frontal placement in scenarios where the frontal position is the surgical site or is inaccessible during the maintenance of general anesthesia as in neurosurgery with particular emphasis on skin preparation and proper positioning of BIS electrodes to improve the signal quality.

Keywords

supralabial - bispectral index - intraoperative awareness


Publication History

Article published online:
09 December 2022

© 2022. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. Lancet 2000; 355 (9205): 707-711
    CrossrefPubMedGoogle Scholar
  • 2 Sebel PS, Bowdle TA, Ghoneim MM. et al. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg 2004; 99 (03) 833-839
    CrossrefPubMedGoogle Scholar
  • 3 Whitlock EL, Rodebaugh TL, Hassett AL. et al. Psychological sequelae of surgery in a prospective cohort of patients from three intraoperative awareness prevention trials. Anesth Analg 2015; 120 (01) 87-95
    CrossrefPubMedGoogle Scholar
  • 4 Domino KB, Posner KL, Caplan RA, Cheney FW. Awareness during anesthesia: a closed claims analysis. Anesthesiology 1999; 90 (04) 1053-1061
    CrossrefPubMedGoogle Scholar
  • 5 Avidan MS, Zhang L, Burnside BA. et al. Anesthesia awareness and the bispectral index. N Engl J Med 2008; 358 (11) 1097-1108
    CrossrefPubMedGoogle Scholar
  • 6 Castellon-Larios K, Rosero B, Niño-de Mejía M, Bergese S. The use of cerebral monitoring for intraoperative awareness. Colombian Journal of Anesthesiology. 2016; 44 (01) 23-29
    PubMedGoogle Scholar
  • 7 Hajat Z, Ahmad N, Andrzejowski J. The role and limitations of EEG-based depth of anaesthesia monitoring in theatres and intensive care. Anaesthesia 2017; 72 (Suppl. 01) 38-47
    CrossrefPubMedGoogle Scholar
  • 8 Pandin P, Van Cutsem N, Tuna T, D'hollander A. Bispectral index is a topographically dependent variable in patients receiving propofol anaesthesia. Br J Anaesth 2006; 97 (05) 676-680
    CrossrefPubMedGoogle Scholar
  • 9 Lee SY, Kim YS, Lim BG, Kim H, Kong MH, Lee IO. Comparison of bispectral index scores from the standard frontal sensor position with those from an alternative mandibular position. Korean J Anesthesiol 2014; 66 (04) 267-273
    CrossrefPubMedGoogle Scholar
  • 10 Johansen JW, Sebel PS, Sigl JC. Clinical impact of hypnotic-titration guidelines based on EEG bispectral index (BIS) monitoring during routine anesthetic care. J Clin Anesth 2000; 12 (06) 433-443
    CrossrefPubMedGoogle Scholar
  • 11 Sinha P, Koshy T. Monitoring devices for measuring the depth of anaesthesia-an overview. Indian J Anaesth 2007; 51 (05) 365-365
    PubMedGoogle Scholar
  • 12 Giavarina D. Understanding Bland Altman analysis. Biochem Med (Zagreb) 2015; 25 (02) 141-151
    CrossrefPubMedGoogle Scholar
  • 13 Nelson P, Nelson JA, Chen AJ, Kofke WA. An alternative position for the BIS-vista montage in frontal approach neurosurgical cases. J Neurosurg Anesthesiol 2013; 25 (02) 135-142
    CrossrefPubMedGoogle Scholar
  • 14 Shiraishi T, Uchino H, Sagara T, Ishii N. A comparison of frontal and occipital bispectral index values obtained during neurosurgical procedures. Anesth Analg 2004; 98 (06) 1773-1775
    CrossrefPubMedGoogle Scholar
  • 15 Akavipat P, Hungsawanich N, Jansin R. Alternative placement of bispectral index electrode for monitoring depth of anesthesia during neurosurgery. Acta Med Okayama 2014; 68 (03) 151-155
    PubMedGoogle Scholar
  • 16 Ekman A, Lindholm ML, Lennmarken C, Sandin R. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand 2004; 48 (01) 20-26
    CrossrefPubMedGoogle Scholar