The effect of addition of nitrous oxide or remifentanil to sevoflurane anesthetic on BIS in pediatric patients

The Effect of Addition of Nitrous Oxide or Remifentanil toSevoflurane Anaesthetic on BIS in Pediatric PatientsNesrin Alpaslan Yigit, MDTraditionally MAC, end tidal inhalational anaesthetic concentrations and autonomicnervous system responses such as hypertension, tachycardia, pupil dilatation, movement to anoxious stimulus are all used to assess the depth of anaesthesia in children.In this prospective study, we investigated the relationship between ETsev, MAC andBIS values and the effect of addition of N2O or remifentanil to a constant ETsev con-centration on BIS in children aged 3 to 12 year. The patients were divided into two groupaccording to addition of N2O or remifentanil for analgesia. The depth of anaesthesia wasevaluated with clinical signs. We were not aware of BIS during the study, BIS values wastransferred to a computer continuously and was evaluated after the completion of the study.Supplementing sevoflurane with N2O result in a significant change in BIS and MAClevels. While MAC increased with the addition of N2O to sevoflurane, BIS decreased. InGroup N motor response to noxious stimulus have been developed in eight children.Furthermore MAP and HR values were higher than Group R. Although BIS measurementsremain high in Grup R, there were not seen any clinical sign to noxious stimulus.In conclusion, the use of clinical signs together with BIS should be recommended asan indicator of anaesthesia for the children?s safety since neither traditionally methods norBIS device itself alone is not adequate for the monitoring depth of anaesthesia in pediatricpatients who had been given sevoflurane plus nitrous oxide or remifentanil.