Target-controlled intravenous anaesthesia with bispectral index monitoringfor thoracotomy in a patient with severely impaired left ventricular function

The anaesthetic management of an elderly patient with severely impaired lef t ventricular function undergoing thoracotomy and lobectomy is described. T otal intravenous anaesthesia (TIVA) with remifentanil and target-controlled infusion of propofol titrated according to the bispectral index (BIS) was used, with thoracic epidural anaesthesia commenced at the end of surgery pr oviding postoperative analgesia. Avoidance of intraoperative epidural local anaesthetics and careful titration and dose reduction of propofol using th e BIS was associated with excellent haemodynamic stability. The rapid offse t of action of remifentanil and low-dose propofol facilitated early recover y and tracheal extubation. The BIS was a valuable monitor in optimal titrat ion of TIVA.