title: Relationship between clinical endpoints for induction of anesthesia and bispectral index and effect-site concentration values.
abstract: OBJECTIVE
  To assess the relationship between clinical endpoints for induction of anesthesia and the electroencephalographic (EEG) bispectral index (BIS) and effect-site concentration (C(E)) values when using a target-controlled infusion (TCI) of either thiopental sodium or propofol, by hypothesizing that yawning may be a useful alternative to other commonly used clinical signs for determining loss of consciousness.
  
  
  METHODS
  Randomized observational clinical study.
  
  
  METHODS
  Operating room of a university-based hospital.
  
  
  METHODS
  60 healthy adult patients (aged 20-50 yrs) scheduled for elective surgery with general anesthesia.
  
  
  METHODS
  During a TCI of propofol (n = 30) or thiopental (n = 30), clinical endpoints for loss of verbal responsiveness (LOV), loss-of-eyelash reflex (LOE), occurrence of yawning, and apnea were assessed at 15-second intervals. In addition, BIS and C(E) values were recorded at each of the endpoints.
  
  
  RESULTS
  In both anesthetic groups, the sequence of occurrence of the clinical endpoints was similar, namely LOV, LOE, yawning, and, lastly, apnea. Compared with LOV and LOE, yawning was associated with lower BIS and higher C(E) values with both anesthetics. The frequency of yawning was higher with thiopental than propofol (83% vs. 63%, respectively). However, the frequency of apnea was higher with propofol than thiopental (77% vs. 53%, respectively).
  
  
  CONCLUSIONS
  The correlation of the clinical endpoints with BIS and C(E) values was highest for LOV. Yawning was as unreliable as LOE for determining the onset of unconsciousness during induction of anesthesia. This clinical sign failed to be observed in 17% and 37% of patients induced with thiopental and propofol, respectively.
authors.affiliation: Department of Anesthesiology, The Catholic University of Korea, Seoul, Korea.
authors.forename: Dae Woo
authors.initials: DW
authors.lastname: Kim
authors.forename: Ho Yeong
authors.initials: HY
authors.lastname: Kil
authors.forename: Paul F
authors.initials: PF
authors.lastname: White
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001767:Blinking; D003071:Cognition; D004569:Electroencephalography; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage; D013874:Thiopental / Q000008:administration & dosage; D014474:Unconsciousness / Q000175:diagnosis*; D015000:Yawning
chemical_list: D018686:Anesthetics, Intravenous; D013874:Thiopental; D015742:Propofol