Bispectral Index Monitoring in a Severe Comatose Patient During Surgery

A comatose patient required a tracheostomy. His Glasgow Coma Score was 4 and he was intubated with mydriatic and isochoric pupils, without corneal and light reflexes. Two previous EEGs showed signs of severe and diffuse encephalopathy (arreactive delta and theta rhythms) and there were no somatosensory evoked potentials recordable at the scalp. When the tracheostomy procedure was carried out, the Bispectral Index (BIS) helped to titrate the hypnotic and analgesic requirements keeping the haemodynamic parameters stable. IMPLICATIONS STATEMENT A comatose patient had to undergo surgery. We guided the hypnotic and analgesic requirements by the bispectral index. The bispectral index (BIS) has been used in severely comatose patients as an assessment of the onset of brain death [1]. Moreover, in patients in a persistent vegetative state, BIS has helped to guide anaesthetic depth during surgery [2]. We show the clinical state, electrophysiological tests and the anaesthetic management of a patient in coma after cardiac arrest due to near drowning, who needed to undergo a tracheostomy.