Sedation with propofol during combined spinal epidural anesthesia: comparison of dose requirement of propofol with and without BIS monitoring

Bispectral [BIS] monitoring provides an objective, non-invasive measure of the level of consciousness in sedated patients. Sedation has been shown to increase patient satisfaction during regional anesthesia. Propofol is extensively being used as a sedative, providing sedation while patients remain cooperative and can be easily aroused. In this study, we sought to determine whether BIS is a useful adjunctive manoeuvre to reduce the sedative dose of propofol by using BIS. Forty patients of ASA grade I and II, weighing between 30 to 60 kg, undergoing elective gynecological surgery of about 60 minutes duration were included in the study, and randomly divided into two groups. All patients received combined spinal epidural anesthesia [CSEA]. The patients in Group-P [n=20] received propofol without BIS monitoring and those in Group-PB [n=20], received propofol under BIS monitoring. Total doses of propofol consumed in all patients were calculated and compared using paired t-test. A p-value <0.05 was considered to be significant. The mean total dose of propofol consumed was 130.25 mg +/- 46.95 without BIS monitoring [Group-P] compared to 68.49 mg +/- 12.59 in patients [Group-PB] in which BIS was used to monitor the desired sedation level [P< 0.001]. Mean dose to reach required level of sedation was also reduced [68.35 +/- 21.10 vs 29.01 +/- 9.45, P< 0.001]. Use of BIS during propofol infusion reduces requirement of propofol for sedation during regional anesthesia

Anesthesia for elective cesarean section in a patient with congenital acyanotic heart disease

We report a case of a pregnant lady with a ventricular septal defect [VSD] of 6 mm size and moderate pregnancy induced hypertension [PAH], with 34 weeks gestation, admitted to our hospital for delivery. She was prepared for Cesarean section under epidural anesthesia. Due to failure of epidural technique, we had to carry out the procedure under spinal anesthesia using 1.5 ml of 0.5% inj. bupivacaine heavy with 25 micro g fentanyl. Ampicillin and gentamicin were administered for prophylaxis against bacterial endocarditis. Hypotension was treated with bolus doses of injection phenylephrine 100 micro g along with titrated infusion of intravenous Ringer's lactate solution. Patient was monitored in PACU for 6 hour and then shifted to HDU. The recovery was satisfactory and postoperative stay was uneventful