title: The bispectral index declines during neuromuscular block in fully awake persons.
abstract: Bispectral index (BIS) is an electroencephalographic variable promoted for measuring depth of anesthesia. Electromyographic activity influences surface electroencephalography and the calculation of BIS. In this study, we sought to determine the effect of spontaneous electromyographic activity on BIS. BIS was monitored in three volunteers by using an Aspect A-1000 monitor. The experiment was repeated in one volunteer. Electromyographic activity was recorded. Alcuronium and succinylcholine were administered. No other drugs were used. In parallel with spontaneous electromyographic activity of the facial muscles, BIS decreased in response to muscle relaxation to a minimum value of 33 and, in the repeated measurement, to a minimum value of 9 when total neuromuscular block was achieved. In two volunteers, no total block was achieved. BIS decreased to a minimal value of 64 and 57, respectively. In turn, recovery of BIS coincided with the reappearance of spontaneous electromyographic activity. During the entire experiment, the volunteers had full consciousness. BIS, assessed by software Version 3.31, correlates with spontaneous electromyographic activity of the facial muscles. BIS failed to detect awareness in completely paralyzed subjects. Thus, in paralyzed patients, BIS monitoring may not reliably indicate a decline in sedation and imminent awareness.
  
  
  CONCLUSIONS
  The bispectral index (BIS) is an electroencephalographic variable intended for measuring depth of anesthesia. Electromyographic activity influences the calculation of BIS. We found that the administration of a muscle relaxant to unanesthetized volunteers decreases the bispectral index value. Thus, awareness in totally paralyzed patients cannot be excluded.
authors.affiliation: Departments of *Anesthesiology and †Neurosurgery, Friedrich-Alexander Universität, Erlangen-Nuernberg, Germany; and ‡Department of Anesthesiology, Frankenwaldklinik, Kronach, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Messner
authors.forename: U
authors.initials: U
authors.lastname: Beese
authors.forename: J
authors.initials: J
authors.lastname: Romstöck
authors.forename: M
authors.initials: M
authors.lastname: Dinkel
authors.forename: K
authors.initials: K
authors.lastname: Tschaikowsky
mesh_terms: D000443:Alcuronium; D003243:Consciousness / Q000502:physiology*; D004569:Electroencephalography / Q000187:drug effects*; D004576:Electromyography; D005152:Facial Muscles / Q000502:physiology; D006801:Humans; D009126:Muscle Relaxation; D019148:Neuromuscular Blockade; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D013390:Succinylcholine
chemical_list: D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D013390:Succinylcholine; D000443:Alcuronium