In conclusion, this study presents a detailed descriptive analysis of propofol anesthesia in MO adolescents. Although BIS has been found to improve clinically important outcomes in children undergoing inhalation anesthesia, it is not a standard monitor in paediatric anesthetic practice. In MO adults, La Colla et. al. concluded that it is advisable to administer propofol to MO patients by titration to targeted processed-EEG values. Our findings suggest that in the absence of evidence based dosing guidelines for propofol administration in this MO paediatric population, use of only clinical parameters to dose TIVA with propofol can result in excessive depth of anesthesia. In this setting, BIS monitoring provides anesthesiologists information about real time trend of anesthetic depth and helps prevent excessive propofol administration and associated negative consequences. Our findings also emphasize the need for improved propofol dosing guidelines and monitoring during TIVA in MO adolescents to minimize relative overdosing and its negative consequences.
BIS: Bispectral index; MO: Morbidly obese; TIVA: Total Intravenous anesthesia; RSS: Ramsay sedation score
The authors declare that they have no competing interests.
VC was involved in design, conduct of the study, analysis of the data, and manuscript preparation, SS helped design, conduct the study, and write the manuscript, JD helped design the study and write the manuscript, HE was involved in conduct of the study, SC helped conduct the study and analyze propofol, BS analyzed the data, PS participated in the conduct of the study and manuscript writing, TI helped conduct of the study, AAV and CAK were involved in designing the study, analysis of the data, and preparation of the manuscript. All authors read and approved the final manuscript.
We would like to acknowledge the Teen Longitudinal Assessment of Bariatric Surgery, Cincinnati Children's Hospital Medical Center (reference https://www.Teen-LABS.org) for their support; and Aspect Medical Systems, Norwood, MA for loan of BIS monitor for this study. We also acknowledge the help of Elke HJ Krekels, M.Sc. and Lily Ding, PhD. In biostatistics in reviewing the manuscript.
BMC Anesthesiol. 2013;13(8) © 2013 BioMed Central, Ltd.