A comparison of effects of propofol or remifentanil bolus on BIS variations during tracheal suction in mechanically ventilated critically ill patients

Background and objective of study

The tracheal suction – a part of routine care in ICU – is a nociceptive stimuli. We evaluated the impact of remifentanil or propofol bolus on Bispectral index variations and cardiovascular response to tracheal suction in ICU sedated patients.

Patients and methods

Nineteen ICU sedated (midazolam), mechanically ventilated patients were enrolled into a prospective pilot study.

Observation

Continuous monitoring BIS, cardiovascular parameters measured before and after administration of drug (propofol 100 mg or remifentanil 1 μg/kg), and after suctioning. All patients received propofol, and for next routine suctioning remifentanil.

Results

The steady-state BIS value was 52.21 ± 9.9. After administration of propofol and remifentanil, BIS decreased significantly: 31.5 ± 15.9 vs 37.64 ± 9.1, respectively. During the first minute after suctioning, a higher increase in BIS level was observed for remifentanil (72 ± 16.28) than for propofol (63.14 ± 30). The mean duration of returning the BIS value to baseline was for propofol 23.5 ± 7 min and for remifentanil 14.2 ± 9 min (P < 0.05). Systolic arterial pressure was initially 125 ± 12.97 mmHg and decreased significantly after administration of propofol and remifentanil: 107.35 ± 22.12 mmHg vs 107.5 ± 20.53 mmHg, respectively. After suctioning SAP increased more for propofol (120 ± 20.45 mmHg) than for remifentanil (113.21 ± 24.33 mmHg). The HR initially was 95.78 ± 14.84 bpm, and changed after administration of drugs: 94.85 ± 17.61 bpm vs 95.78 ± 20.26 bpm for propofol and remifentanil, respectively, and after suctioning: 100.64 ± 16.45 vs 97.43 ± 20.62 bpm, respectively.

Conclusion

Propofol and remifentanil altered the BIS variation and cardiovascular response to tracheal suctioning in similar way. However, remifentanil seemed to be more effective in providing the required level of sedation. We found BIS monitoring helpful during routine care in the ICU.