Extubation Time after Target-Controlled Infusion of Propofol Guided by Clinical Signs only versus Bispectral Index and Clinical Signs in Patients Undergoing Spine Surgery: A Randomized Open Labeled Study
Manee Raksakietisak FRCA*, Narin Plailaharn MD**, Phuriphong Songarj MD*, Wannachat Kratayjan BNS*
Affiliation : * Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Anesthesiology, Faculty of Medicine Khon Kaen University, Khon Kaen, Thailand
Objective : To compare using bispectral index (BIS)-guided with clinical signs-guided for TCI propofol on extubation time.
Material and Method: All patients received total intravenous anesthesia that included TCI of propofol (3-7 mcg/dL; Schnider
model) and continuous intravenous fentanyl infusion. The patients were randomly divided into two groups, Non-BIS group
and BIS group. The dose of propofol was adjusted according to clinical signs in the non-BIS group, while BIS (target 40 to 60)
was used in the BIS group. The assessed outcomes were extubation time and total propofol dose.
Results : Thirty-four patients were analyzed; 17 patients in each group with mean ages were 48.0+12.1 (non-BIS) vs.
50.1+11.6 (BIS) years, (p = 0.61). There were no significant differences between groups in patient demographics, and the
most common diagnosis was spinal cord tumor. The two groups did not significantly differ in extubation time [16.6+8.9 (non-
BIS) vs.16.3+9.7 (BIS) minutes, p = 0.91] or total propofol consumption [2,340+839 (non BIS) vs. 2,146+742 (BIS) mg, p
= 0.48]. There were no significant differences between groups in other intraoperative parameters such as fentanyl dose,
major movement, blood loss, and operative time.
Conclusion : In spine surgery, BIS monitor added up to clinical signs monitoring has little value and it has no significant
effects to patients’ extubation time.
Keywords : Propofol, Target controlled infusion (TCI), Bispectral index (BIS), Extubation time
