title: Systolic blood pressure, not BIS, is associated with movement during laryngoscopy and intubation.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Du service d'anesthésie-réanimation Hôpital Henri-Mondor, AP-HP et Université Paris XII, Créteil, France.
authors.forename: Velislav
authors.initials: V
authors.lastname: Slavov
authors.forename: Cyrus
authors.initials: C
authors.lastname: Motamed
authors.forename: Nicole
authors.initials: N
authors.lastname: Massou
authors.forename: Yves
authors.initials: Y
authors.lastname: Rebufat
authors.forename: Philippe
authors.initials: P
authors.lastname: Duvaldestin
mesh_terms: D000759:Adjuvants, Anesthesia; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation; D001794:Blood Pressure / Q000502:physiology*; D004558:Electric Stimulation; D004569:Electroencephalography / Q000187:drug effects*; D005283:Fentanyl; D005542:Forearm / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D009119:Muscle Contraction / Q000187:drug effects; D009125:Muscle Relaxants, Central; D018482:Muscle, Skeletal / Q000187:drug effects; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide
chemical_list: D000759:Adjuvants, Anesthesia; D018685:Anesthetics, Inhalation; D009125:Muscle Relaxants, Central; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D005283:Fentanyl