Ho Yeong Kil

The effect of noise on the bispectral index during propofol sedation

Because noise in the operating room has been alleged to interfere with the ability to sedate patients before surgery, we evaluated the effect of noise on the Bispectral index (BIS) value during propofol sedation. Thirty unpremedicated patients were studied before the start of surgery while receiving propofol sedation on two separate occasions according to a randomized, crossover protocol design. After achieving a stable baseline BIS value of either 75 or 80 with a target-controlled infusion of propofol, an external sound source administered noise at 50, 80, 110, and 120 dB. The changes in the BIS value were recorded over a 1-min interval at each noise level. In the BIS 75 group, increasing levels of noise did not significantly alter the BIS value. However, in the BIS 80 group, the BIS values at 80, 110, and 120 dB were significantly higher compared to the value at 50 dB. In conclusion, experimental noise increases the BIS and appears to have a greater effect on the BIS value at “lighter” levels of propofol sedation.

Relationship between clinical endpoints for induction of anesthesia and bispectral index and effect-site concentration values.

STUDY OBJECTIVE To assess the relationship between clinical endpoints for induction of anesthesia and the electroencephalographic (EEG) bispectral index (BIS) and effect-site concentration (C(E)) values when using a target-controlled infusion (TCI) of either thiopental sodium or propofol, by hypothesizing that yawning may be a useful alternative to other commonly used clinical signs for determining loss of consciousness. DESIGN Randomized observational clinical study. SETTING Operating room of a university-based hospital. PATIENTS 60 healthy adult patients (aged 20-50 yrs) scheduled for elective surgery with general anesthesia. INTERVENTIONS During a TCI of propofol (n = 30) or thiopental (n = 30), clinical endpoints for loss of verbal responsiveness (LOV), loss-of-eyelash reflex (LOE), occurrence of yawning, and apnea were assessed at 15-second intervals. In addition, BIS and C(E) values were recorded at each of the endpoints. MEASUREMENTS AND MAIN RESULTS In both anesthetic groups, the sequence of occurrence of the clinical endpoints was similar, namely LOV, LOE, yawning, and, lastly, apnea. Compared with LOV and LOE, yawning was associated with lower BIS and higher C(E) values with both anesthetics. The frequency of yawning was higher with thiopental than propofol (83% vs. 63%, respectively). However, the frequency of apnea was higher with propofol than thiopental (77% vs. 53%, respectively). CONCLUSION The correlation of the clinical endpoints with BIS and C(E) values was highest for LOV. Yawning was as unreliable as LOE for determining the onset of unconsciousness during induction of anesthesia. This clinical sign failed to be observed in 17% and 37% of patients induced with thiopental and propofol, respectively.