Propofol induction in traumatic brain injury patients using BIS and TCI

Traumatic brain injury (TBI) is a substantial cause of death, morbidity, and functional impairment and is a major worldwide public health problem. The necessity for the anesthetic agent needed for inducing general anesthesia in patients with TBI is of great importance since patients with TBI commonly need emergency surgery. When compared to patients with mild and moderate head injuries, it is sometimes assumed that patients with sTBI would need less anesthesia; however, there is no research on this topic. The goal of this research was to determine if patients receiving emergency surgery for TBIs of various grades had distinct medication needs. Using a target controlled infusion (TCI) pump, determine the propofol dosage needed to induce anesthesia based on plasma (Cp) and effect (Ce) site concentration. The endpoint for induction was assessed using BIS in a recently published research that examined the dosage needed of propofol for induction of anesthesia in patients with various stages of TBI having surgery (i.e., difference of Cp/Ce across the groups).

Patients with mild, moderate, and severe grades of TBI who had emergency surgery within 48 hours after the injury were included in this prospective, observational research. Bilateral BIS sensors were used to capture Bispectral Index (BIS) values. Using a target controlled infusion (TCI) pump, anesthesia was brought on. When BIS reached 40, the TCI pump recorded the needed total dosage of propofol, plasma (Cp), and effect-site (Ce) concentrations. Of the 96 patients enrolled, 27, 36, and 33 individuals, respectively, were classified as having mild, moderate, or severe TBI (sTBI). Propofol's Ce in the mild, moderate, and sTBI groups was 6 0.9, 5.82 0.98, and 4.48 1.5 g/mL (P 0.001), respectively, and the dosage needed was 1.9 0.2, 1.8 0.4, and 1.41 0.5 mg/kg (P 0.001). In the mild, moderate, and sTBI groups, the baseline BIS on the damaged side was 80 7.8, 71 9.4, 55 11.6, while on the uninjured side, it was 89 5.5, 81 8.4, and 65 12.

This research showed that patients with sTBI needed considerably less propofol than patients with moderate TBI for the induction of anesthesia as determined by Cp and Ce. When compared to individuals with lesser injuries, people with sTBI need much less propofol to induce anesthesia. Propofol dosage is greater for female patients than for male ones. A unique, noninvasive monitor called bilateral BIS may be used to predict neurological outcomes after a traumatic brain injury (TBI), measure interhemispheric variations in EEG, and evaluate the endpoint of induction. It is recommended to provide lower dosages of propofol to patients with sTBI as a result of this study's potential therapeutic use. This may assist in avoiding hypotension, a recognized secondary damage in TBI patients.

Reference –

Syeda, Seham; Bansal, Sonia; Chakrabarti, Dhritiman; Bhadrinarayan, V.. The requirement of propofol for induction of anesthesia in patients with traumatic brain injury determined using bilateral bispectral index and target controlled infusion – An observational cohort study. Journal of Anaesthesiology Clinical Pharmacology 39(2):p 208-214, Apr–Jun 2023. | DOI: 10.4103/joacp.joacp_216_21