title: Muscle relaxation does not alter hypnotic level during propofol anesthesia.
abstract: Electromyographic (EMG) activity can contaminate electroencephalographic signals. Paralysis may therefore reduce the Bispectral Index (BIS) by alleviating artifact from muscles lying near the electrodes. Paralysis may also reduce signals from muscle stretch receptors that normally contribute to arousal. We therefore tested the hypothesis that nondepolarizing neuromuscular block reduces BIS. Ten volunteers were anesthetized with propofol at a target effect site concentration of 3.8 plus/minus 0.4 microg/mL. A mivacurium infusion was adjusted to vary the first twitch (T1) in a train-of-four to 80%, 30%, 20%, 15%, 10%, 5%, or 2% of the prerelaxant intensity. At each randomly assigned T1, we measured BIS and frontal-temporal EMG intensity. BIS averaged 95 plus/minus 4 before induction of anesthesia, and decreased significantly to 40 plus/minus 5 after propofol administration. However, there were no significant differences at the designated block levels. Frontal-temporal EMG intensity averaged 47 plus/minus 3 dB before induction of anesthesia, and decreased significantly to 27 plus/minus 1 dB after propofol administration. However, there were no significant differences at the designated block levels. These data suggest that the BIS level and EMG tone are unaltered by mivacurium administration during propofol anesthesia.
  
  
  CONCLUSIONS
  Neuromuscular block level did not alter Bispectral Index (BIS) during propofol anesthesia, either by reducing electromyographic artifact or by decreasing afferent neuronal input. The BIS will thus comparably estimate sedation in deeply unconscious patients who are paralyzed, partially paralyzed, or unparalyzed.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Donauspital-SMZO, Vienna, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Greif
authors.forename: Scott
authors.initials: S
authors.lastname: Greenwald
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Schweitzer
authors.forename: Sonja
authors.initials: S
authors.lastname: Laciny
authors.forename: Angela
authors.initials: A
authors.lastname: Rajek
authors.forename: James E
authors.initials: JE
authors.lastname: Caldwell
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
mesh_terms: D000328:Adult; D000758:Anesthesia; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D004569:Electroencephalography / Q000187:drug effects*; D004576:Electromyography; D005260:Female; D006801:Humans; D007546:Isoquinolines / Q000494:pharmacology*; D008297:Male; D000077590:Mivacurium; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*; D015742:Propofol / Q000494:pharmacology*
chemical_list: D018686:Anesthetics, Intravenous; D007546:Isoquinolines; D003473:Neuromuscular Nondepolarizing Agents; D000077590:Mivacurium; D015742:Propofol