Paradoxical Increase in the Bispectral Index during Deep Anesthesia in New Zealand White Rabbits

Objective monitoring of the level of anesthesia is crucial in carefully controlled translational neuroscience studies. The usefulness of bispectral index (BIS) in monitoring human anesthesia is well established. However, the validity of its application remains unproven in laboratory animals. We assessed whether BIS could be used reliably in monitoring the depth of deep anesthesia in 8 New Zealand white rabbits. Experimental baseline anesthesia was maintained with continuous infusion of propofol and administration of isoflurane, both of which were titrated to EEG activity. The rabbits were allocated randomly to receive 3 increasing concentrations of common anesthetic drugs (etomidate, propofol, and isoflurane) aimed to produce burst suppression of EEG activity yielding at least 10 s of sustained EEG silence. Rabbits had a 20-min recovery interval between challenges. Transient cerebral hypoperfusion to produce reversible EEG silence due to ischemia was induced as a fourth challenge, followed by terminal arrest, in each animal. BIS, EEG, and physiologic data were analyzed for each rabbit. We observed stable BIS values in the range of 40 to 60 during the administration of baseline anesthesia. However, as the depth of anesthesia deepened with the anesthetic drug challenges, the BIS value paradoxically increased with increasing doses. The BIS signal quality index declined while the total power decreased. In contrast to these unexpected results, BIS values decreased rapidly to near 0 during terminal arrest, as expected. Therefore, we do not consider BIS to be a useful method for monitoring deep levels of anesthesia in laboratory rabbits.