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Med Gas Res. 2019 Jan 9;8(4):150-153. doi: 10.4103/2045-9912.248265. eCollection 2018 Oct-Dec.

Frequency of anesthetic overdose with mean alveolar concentration-guided anesthesia at high altitude.

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Cardiothoracic Anesthesia Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
Universidad del Rosario, Bogotá, Colombia.
Vascular Function Research Laboratory, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.


This study reported the frequency of anesthetic overdose measured with the bispectral index in a high altitude city (Bogotá-Colombia, 2600 meters above sea level). We assembled a prospective cohort of patients. Preoperative variables were described, and 10 minutes after the surgical incision, bispectral index, mean alveolar concentration, mean arterial pressure, and oxygen saturation were recorded. Bispectral index was classified as superficial (60), adequate (40-60), and deep (> 40). Mean alveolar concentration was classified as low (< 0.8), normal (0.8-1.2), and high (> 1.2). We included 50 patients. The mean age of the patients was 36.3 ± 13.5 years; 48% were male and 78% were categorized as ASA I. Mean values of mean alveolar concentration and bispectral index were 1.14 ± 0.18 and 38.66 ± 6.9, respectively. Frequency of anesthetic overdose measured with bispectral index was 54% and only 20% with mean alveolar concentration. In total, 78% of patients received normal mean alveolar concentration values, and among these patients, 49% had deep bispectral index levels and 51% were adequate. There was no correlation between mean alveolar concentration and bispectral index (Pearson r = 0.161, P = 0.246) or between bispectral index and mean arterial pressure (Pearson r = 0.367, P = 0.08). All patients older than 60 years exhibited deep bispectral index levels, and although we did not identify a correlation between age and bispectral index, a tendency was observed (Pearson r = -0.087, P = 0.538). Safe and effective anesthesia overdose could be a common phenomenon. Bispectral index-guided anesthesia could be a helpful and reliable tool in the assessment and prevention of anesthesia overdose at high altitude. The study was approved by the ethics committee of the Fundación Cardioinfantil-Instituto de cardiología, Bogota, Colombia (approved number: 312017).


altitude; biespectral index; drug overdose; general anesthesia; inhalation; intraoperative awareness; mean alveolar concentration

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