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Systolic blood pressure, not BIS, is associated with movement during laryngoscopy and intubation

[Contrairement au niveau du BIS, le niveau de pression artérielle systolique est associé aux mouvements lors de la laryngoscopie et l’intubation]

Du service d’anesthésie-réanimation Hôpital Henri-Mondor, AP-HP et Université Paris XII, Créteil, France.

Address correspondence to: Dr. C. Motamed, Service d’anesthésie-réanimation, Hôpital Henri Mondor-AP-HP et Université Paris XII, 51 Ave. Maréchal De Lattre de Tassigny, 94010 Créteil, France. Phone: 01-49-81-2383; Fax: 01-49-81-2380; E-mail: cyrus.motamed{at}hmn.ap-hop-paris.fr

Objective: To compare bispectral index (BIS) values to hemodynamic variations, in order to evaluate adequacy of anesthesia during orotracheal intubation with muscle relaxants.

Methods: Forty-one patients ASA I–II, scheduled for elective peripheral surgery under general anesthesia with tracheal intubation were enrolled in the study. Fentanyl/thiopental followed by vecuronium were used for induction. Onset of relaxation was monitored at the orbicularis occuli (OO) muscle using train-of-four stimulation. Intubation was performed when no response at the OO was detected visually. Intubating conditions were noted. The "isolated forearm" technique was used to detect movement during laryngoscopy/intubation. BIS values, pulse rate (PR), and systolic pressure were recorded before induction, during laryngoscopy/intubation and 60 sec after intubation.

Results: Although intubating conditions were clinically adequate for all patients, ten out of 41 had movement of the isolated arm during laryngoscopy/intubation. BIS values were not significantly different for these patients: 67 (55–83) compared to those who had no movement: 60 (35–80), P = 0.6. During laryngoscopy, PR increased for all patients while systolic pressure increased significantly only in patients who moved: 125 (100–136) mmHg vs those who did not: 108 (67–140), P < 0.05.

Conclusion: Systolic pressure elevations were associated with inadequate anesthesia as evaluated by the "isolated forearm" technique, during laryngoscopy/intubation. BIS values were not different between groups, suggesting that systolic blood pressure may be a better predictor of inadequate anesthesia under the circumstances described.

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