The relationship between bispectral index and targeted propofol concentration is biphasic in patients with major burns

Background: Many pathophysiologic alterations in major burns can cause changes in the distribution of, and perhaps response to, drugs commonly used in anesthesia practice. This study was conducted to assess changes in bispectral index (BIS) caused by increasing the target propofol effect‐site concentration during a target‐controlled infusion (TCI) in major burns. Methods: Eighteen patients, ASA physical status 2 or 3, aged from 20 to 55 years old, weighing 50–70 kg, with major burns, scheduled for elective early escharectomy less than a week after injury were recruited. A further 18 ASA physical status class 1 or 2, non‐burns, age, sex‐ and weight‐matched adult patients scheduled for elective surgery under general anesthesia were recruited as controls. During anesthesia induction, target propofol effect‐site concentrations were increased by increments of 0.5 µg ml−1 up to 4.5 µg ml−1. The BIS responses to each target concentration using TCI were compared in both groups. Results: In the burns group, significantly greater BIS values relating to increasing propofol TCI were noted at deeper anesthesia when compared with controls; at ≥3.5 µg ml−1; mean BIS remained at a plateau of about 50. Patients with burns had higher cardiac indices, and lower hemoglobin and albumin concentrations than the controls. They consumed more vecuronium to maintain the same degree of neuromuscular blockade than the controls. Conclusions: In major burns, the final biphasic BIS responses appeared to be determined by numerous other variables such as BIS algorithm, TCI performance, and altered propofol pharmacokinetics and pharmacodynamics. According to our results the importance of an individually tailored approach, including careful anesthetic titration, based upon the patient's clinical condition and responses can not be overemphasized.