Document Detail

Bispectral Index (BIS) may not predict awareness reaction to intubation in surgical patients.
MedLine Citation:
PMID:  11773816     Owner:  NLM     Status:  MEDLINE    
Bispectral Index (BIS) has been marketed as a measure of the hypnotic component of anesthesia and is recommended as a guide for the administration of hypnotic drugs during anesthesia. BIS values between 40 and 60 are recommended for surgery under general anesthesia. This study investigates whether a BIS baseline between 50 and 60 prevents awareness reaction to endotracheal intubation. After approval by the university's Ethics Committee, 20 consenting patients were enrolled in the study. Midazolam (0.1 mg/kg PO) was given 30 minutes before induction. Anesthesia was induced with alfentanil (10 mcg/kg, followed by 2 mcg/kg(-1) x min(-1)) and propofol infusion was adjusted to a BIS target level between 50 and 60. Propofol infusion rate was maintained constant for 5 minutes with constant BIS. Prior to intubation, patients were tested in one-minute intervals for awareness using Tunstall's isolated forearm technique. Three minutes after endotracheal intubation, the study period ended and surgery was performed. After intubation, 8 of 20 patients showed an awareness reaction, squeezing the investigator's hand in response to a command. No patient had recall. Comparison of patients with and without awareness reaction revealed no differences in BIS before or after intubation. This study shows that a BIS value between 50 and 60 prior to intubation is inadequate to prevent an awareness reaction to endotracheal intubation during propofol/alfentanil anesthesia. Because BIS cannot differentiate between patients with and without awareness reaction, its value as a monitor for awareness and a measurement of the hypnotic component of anesthesia must be questioned.
Gerhard Schneider; Klaus Wagner; Wolfram Reeker; Frank Hänel; Christian Werner; Eberhard Kochs
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgical anesthesiology     Volume:  14     ISSN:  0898-4921     ISO Abbreviation:  J Neurosurg Anesthesiol     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2002-01-04     Completed Date:  2002-01-31     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8910749     Medline TA:  J Neurosurg Anesthesiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  7-11     Citation Subset:  IM    
Department of Anesthesiology, Technische Universität München, Munich, Germany.
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MeSH Terms
Anesthesia, General*
Blood Pressure
Electroencephalography* / drug effects
Heart Rate
Intubation, Intratracheal*
Middle Aged
Reg. No./Substance:

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