Bispectral Index (BIS) May Not Predict Awareness Reaction to Intubation in Surgical Patients
作者:
Gerhard Schneider,
Klaus Wagner,
Wolfram Reeker,
Frank Hänel,
Christian Werner,
Eberhard Kochs,
期刊:
Journal of Neurosurgical Anesthesiology
(OVID Available online 2002)
卷期:
Volume 14,
issue 1
页码: 7-11
ISSN:0898-4921
年代: 2002
出版商: OVID
关键词: Anesthesia;General;Anesthesia;Intravenous;Propofol;Electroencephalography;Wakefulness
数据来源: OVID
摘要:
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−/min−) 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.
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