Arousal with iv epinephrine depends on the depth of anesthesia.
OBJECTIVE
To investigate whether the depth of anesthesia affects the change in the bispectral index (BIS) caused by iv epinephrine during propofol anesthesia.


METHODS
Forty women undergoing elective lower abdominal surgery received a propofol target controlled infusion (TCI) to maintain a modified Observer's Assessment of Alertness/Sedation (OAA/S) score of 2 (sedation period). Subsequently anesthesia was induced with propofol TCI 5 mug.mL(-1) and rocuronium 0.9 mg.kg(-1), and propofol continued so as to maintain general anesthesia at a BIS of 50 (general anesthesia period). Intravenous epinephrine at a dose of 10 mug.5 mL(-1) in normal saline (epinephrine group, n = 20) or normal saline 5 mL (control group, n = 20) was administered during both periods. The BIS, mean arterial pressure (MAP) and heart rate (HR) were measured immediately before, and one, two, three, four, six, eight, and ten minutes after injection. The modified OAA/S scale was evaluated during the sedation period.


RESULTS
There was no significant change in the modified OAA/S scale, BIS, or hemodynamic variables compared to preinjection values during either sedation or general anesthesia in the control group. Intravenous epinephrine increased the BIS and modified OAA/S scale during sedation, but there was no increase in BIS during general anesthesia. Increases in HR and MAP were observed during both periods after iv epinephrine.


CONCLUSIONS
Intravenous epinephrine 10 mug resulted in an arousal effect and an increase in BIS during sedation, but did not change the BIS during general anesthesia. These results suggest that the arousal effect of iv epinephrine during propofol anesthesia depends on anesthetic depth.
Shin
Hye-Won
HW
Department of Anesthesiology, Korea University Anam Hospital, 126-1, 5-Ka, Anam-dong, Sungbuk-Ku, Seoul, South Korea 136-705. hyewonmd@unitel.co.kr
Ban
Young-Jun
YJ
Lee
Hye-Won
HW
Lim
Hae-Ja
HJ
Yoon
Suk-Min
SM
Chang
Seong-Ho
SH
D000322:Adrenergic Agonists / Q000008:administration & dosage*; D000328:Adult; D000732:Androstanols / Q000008:administration & dosage; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001143:Arousal / Q000187:drug effects*; D001364:Awareness / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D017558:Elective Surgical Procedures; D004562:Electrocardiography / Q000187:drug effects; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage*; D000077123:Rocuronium
D000322:Adrenergic Agonists; D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium; D015742:Propofol; D004837:Epinephrine