Bispectral monitoring during vital capacity rapid inhalation induction with sevoflurane

Abstract

Study objective To evaluate the variables of bispectral index (BIS) values during vital capacity rapid inhalation induction (VCRII) with sevoflurane. Design Randomized, prospective study. Setting University hospital. Patients 40 ASA physical status I and II patients scheduled for elective orthopedic surgery with general anesthesia. Interventions Patients was divided into two groups, both of which received intravenous (IV) injection of propofol 2 mg/kg followed by inhalation of sevoflurane 3% (Group P), or vital capacity inhalation induction with sevoflurane 8% (Group S). After loss of consciousness, tracheal intubation was performed with vecuronium 0.1 mg/kg. Measurements and main results The induction times in Group P were significantly shorter than those in Group S (p < 0.01). In Group S, BIS values were gradually decreased and maintained the adequate hypnotic levels were maintained during induction. In Group P, although BIS values were rapidly decreased, the values remained higher compared with Group S. The BIS value before intubation in Group S was significantly lower than that in Group P (25 ± 9 and 38 ± 7, respectively; p < 0.01). Five of 20 Group P patients had BIS values exceeding 60 before tracheal intubation, but no patient in Group S had a BIS value as high. Mean arterial pressure immediately after intubation in Group S was significantly lower than that in Group P (p < 0.05). Conclusion VCRII with a high concentration of sevoflurane provided adequate BIS values during induction, suggesting that it may allow smoother transition from anesthesia induction to maintenance, and also maintain an adequate hypnotic level in readiness for certain stimuli such as laryngoscopy and tracheal intubation.