Bispectral index-guided administration of anaesthesia: Comparison between remifentanil/propofol and remifentanil/isoflurane

G. Schneider, C. Elidrissi, Peter S. Sebel

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background and objective: the bispectral index of the electroencephalogram is a measure of the hypnotic component of anaesthesia and can be used to guide the administration of anaesthesia. This study compares bispectral index-guided anaesthesia with remifentanil and either propofol or isoflurane. Methods: Eighty consenting patients were randomly assigned to two groups. Following induction with propofol and remifentanil, anaesthesia was maintained with remifentanil/propofol or remifentanil/isoflurane. Remifentanil infusion rates were guided by haemodynamic responses - maintaining mean arterial pressure and heart rate within 20% of baseline. Propofol and isoflurane administration was guided using the bispectral index (45-60). Thirty minutes before the end of surgery, morphine was administered (0.15 mg kg-1 intravenously). Fifteen minutes before end of surgery, propofol and isoflurane were reduced (bispectral index 60-75). At the end of surgery, the anaesthetic agents were discontinued. Groups were compared for recovery, remifentanil doses and signs of inadequate anaesthesia using the X2-test and ANOVA (P < 0.05). Results: The duration of surgery was longer in the propofol/remifentanil group (121 ± 53 versus 94 ± 40 min). Recovery data were not different between groups. The remifentanil infusion rate was significantly lower with additional isoflurane (0.18 ± 0.06 μg kg-1 min-1) than with additional propofol (0.31 ± 0.20 μg kg-1 min-1). The propofol infusion rate was 123 ± 48 μg kg-1 min-1; isoflurane concentration was 0.66 ± 0.13%. Conclusions: Bispectral index-guided anaesthesia with remifentanil plus propofol or isoflurane results in the absence of postoperative recall and a fast recovery with both drug combinations. In our patients, at comparable bispectral index-levels, haemodynamic control requires higher doses of remifentanil with propofol than with isoflurane.

Original languageEnglish
Pages (from-to)624-630
Number of pages7
JournalEuropean Journal of Anaesthesiology
Issue number8
StatePublished - 1 Aug 2003
Externally publishedYes


  • Anaesthesia, inhalation, intravenous
  • Anaesthetics, inhalation, isoflurane
  • Anaesthetics, intravenous, propofol
  • Anaesthetics, intravenous, remifentanil
  • Electroencephalography
  • Monitoring, intraoperative


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