title: Electroencephalogram bispectral index predicts hemodynamic and arousal reactions during induction of anesthesia in patients undergoing cardiac surgery.
abstract: OBJECTIVE
  To evaluate hemodynamic and clinical responses to induction of anesthesia and intubation at 3 different values of the electroencephalogram bispectral index (BIS).
  
  
  METHODS
  Prospective randomized trial.
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  Forty-five patients undergoing elective coronary artery bypass graft surgery.
  
  
  METHODS
  Patients were assigned to 3 groups (n = 15 for each group). Anesthesia was induced with midazolam, sufentanil, and pancuronium. In each group, sufentanil was titrated to a BIS value of 60, 50, or 40 before intubation. Mean arterial blood pressure, heart rate, incidence of coughing, tearing, and need for fluid replacement or injections of norepinephrine were recorded before intubation as well as immediately and 1 and 2 minutes after intubation.
  
  
  RESULTS
  Thirteen patients intubated at a BIS value of 60 coughed and 14 experienced tearing after intubation, whereas no patient of the other groups showed signs of arousal. Mean arterial blood pressure remained stable in the BIS 60 and 50 groups, whereas in the BIS 40 group it decreased significantly to lower values before and after intubation. Patients in the BIS 40 group needed significantly more fluid replacement and injections of norepinephrine compared with the other groups. No significant changes in heart rate were detected.
  
  
  CONCLUSIONS
  Electroencephalogram BIS predicts hemodynamic and arousal reaction resulting from induction of anesthesia and endotracheal intubation. BIS value should be kept at 50 before intubation to ensure safe hemodynamic conditions during induction of anesthesia in cardiac surgical patients.
authors.affiliation: Department of Anesthesiology and Operative Intensive Care, and the Clinic of Cardiac Surgery, Ludwigshafen am Rhein, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Heck
authors.forename: B
authors.initials: B
authors.lastname: Kumle
authors.forename: J
authors.initials: J
authors.lastname: Boldt
authors.forename: J
authors.initials: J
authors.lastname: Lang
authors.forename: A
authors.initials: A
authors.lastname: Lehmann
authors.forename: W
authors.initials: W
authors.lastname: Saggau
mesh_terms: D000769:Anesthesia, Inhalation; D001143:Arousal / Q000187:drug effects*; D001794:Blood Pressure / Q000187:drug effects; D006348:Cardiac Surgical Procedures; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011229:Preanesthetic Medication; D011446:Prospective Studies