Hostname: page-component-76fb5796d-5g6vh Total loading time: 0 Render date: 2024-04-26T01:48:32.117Z Has data issue: false hasContentIssue false
  • English
  • Français

Inter-patient variability upon induction with sevoflurane estimated by the time to reach predefined end-points of depth of anaesthesia

Published online by Cambridge University Press:  27 January 2006

P. Lambert ,
E. Junke ,
T. Fuchs-Buder ,
C. Meistelman  and
D. Longrois
P. Lambert
Affiliation:
Centre Hospitalier Universitaire de Nancy, Department of Anaesthesia and Intensive Care, Hôpital Brabois,Vandoeuvre-les-Nancy, France
E. Junke
Affiliation:
Centre Hospitalier Universitaire de Nancy, Department of Anaesthesia and Intensive Care, Hôpital Brabois,Vandoeuvre-les-Nancy, France
T. Fuchs-Buder
Affiliation:
Centre Hospitalier Universitaire de Nancy, Department of Anaesthesia and Intensive Care, Hôpital Brabois,Vandoeuvre-les-Nancy, France
C. Meistelman
Affiliation:
Centre Hospitalier Universitaire de Nancy, Department of Anaesthesia and Intensive Care, Hôpital Brabois,Vandoeuvre-les-Nancy, France
D. Longrois
Affiliation:
Centre Hospitalier Universitaire de Nancy, Department of Anaesthesia and Intensive Care, Hôpital Brabois,Vandoeuvre-les-Nancy, France
Get access

Extract

Summary

Background and objectives: A difficult issue in anaesthesia is its titration for an individual patient to avoid over- and underdosage. Common practice is to use an initial dose and increase it subsequently if the defined end-point is not reached. This assumes that the end-point is reached after a similar interval of time in all patients given a similar dose. In order to test this hypothesis we measured the time to reach end-points such as loss of consciousness (LOC), a bispectral index (BIS®) value of 60, the minimal BIS and the minimal mean arterial pressure (MAP) values. Methods: Thirty patients aged 18–60 yr scheduled for general surgery were included in this observational study. After preoxygenation, induction was performed with 6% inspired concentration of sevoflurane in 6 Lmin−1 oxygen using the SiBI® connector and the tidal volume technique. Remifentanil was administered when the BIS value was 60 and tracheal intubation was performed 4 min later. Results: Time (median, minimum–maximum) to LOC, a BIS value of 60, the minimal BIS and MAP values were, respectively, 75 (45–135), 120 (75–270), 300 (120–720) and 450 (120–1200) seconds. The time to the minimal BIS value was significantly (P < 0.05) shorter than the time to reach the minimal MAP value. Conclusions: These results demonstrate large inter-patient variability for the time necessary to reach defined end-points of depth of anaesthesia when a similar dose of anaesthetic is given. Measuring the time to reach a predefined BIS value would allow application of nociceptive stimuli only at adequate levels of hypnosis and would facilitate titration.

Keywords

ANAESTHESIA INHALATIONAL, sevoflurane, patient variationELECTROENCEPHALOGRAPHY, bispectral indexREMIFENTANIL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 4 , April 2006 , pp. 311 - 318
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Drummond JC. Monitoring depth of anesthesia: with emphasis on the application of the bispectral index and the middle latency auditory evoked response to the prevention of recall. Anesthesiology 2000; 93: 876–882.Google Scholar
Iselin-Chaves IA, Flaishon R, Sebel PS et al. The effect of the interaction of propofol and alfentanil on recall, loss of consciousness, and the Bispectral Index. Anesth Analg 1998; 87: 949–955.Google Scholar
Glass PS, Doherty M, Jacobs JR, Goodman D, Smith LR. Plasma concentration of fentanyl, with 70% nitrous oxide, to prevent movement at skin incision [see comments]. Anesthesiology 1993; 78: 842–847.Google Scholar
Scott JC, Cooke JE, Stanski DR. Electroencephalographic quantitation of opioid effect: comparative pharmacodynamics of fentanyl and sufentanil. Anesthesiology 1991; 74: 34–42.Google Scholar
Dixon WJ. Staircase bioassay: the up-and-down method. Neurosci Biobehav Rev 1991; 15: 47–50.Google Scholar
Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology 1998; 89: 980–1002.Google Scholar
Colas MJ, Tetrault JP, Dumais L, Truong P, Claprood Y, Martin R. The SiBI connector: a new medical device to facilitate preoxygenation and reduce waste anesthetic gases during inhaled induction with sevoflurane. Anesth Analg 2000; 91: 1555–1559.Google Scholar
Mertens MJ, Olofsen E, Burm AG, Bovill JG, Vuyk J. Mixed-effects modeling of the influence of alfentanil on propofol pharmacokinetics. Anesthesiology 2004; 100: 795–805.Google Scholar
Ekman A, Brudin L, Sandin R. A comparison of bispectral index and rapidly extracted auditory evoked potentials index responses to noxious stimulation during sevoflurane anesthesia. Anesth Analg 2004; 99: 1141–1146.Google Scholar
Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet 2004; 363: 1757–1763.Google Scholar
Ekman A, Lindholm ML, Lennmarken C, Sandin R. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand 2004; 48: 20–26.Google Scholar
Muzi M, Robinson BJ, Ebert TJ, O'Brien TJ. Induction of anesthesia and tracheal intubation with sevoflurane in adults. Anesthesiology 1996; 85: 536–543.Google Scholar
Kazama T, Ikeda K, Morita K et al. Comparison of the effect-site k(eO)s of propofol for blood pressure and EEG bispectral index in elderly and younger patients. Anesthesiology 1999; 90: 1517–1527.Google Scholar
Flaishon R, Windsor A, Sigl J, Sebel PS. Recovery of consciousness after thiopental or propofol. Bispectral index and isolated forearm technique. Anesthesiology 1997; 86: 613–619.Google Scholar
Guignard B, Menigaux C, Dupont X, Fletcher D, Chauvin M. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg 2000; 90: 161–167.Google Scholar
Forestier F, Hirschi M, Rouget P et al. Propofol and sufentanil titration with the bispectral index to provide anesthesia for coronary artery surgery. Anesthesiology 2003; 99: 334–346.Google Scholar
Struys MM, Jensen EW, Smith W et al. Performance of the ARX-derived auditory evoked potential index as an indicator of anesthetic depth: a comparison with bispectral index and hemodynamic measures during propofol administration. Anesthesiology 2002; 96: 803–816.Google Scholar
Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg 2005; 100: 4–10.Google Scholar