title: Bispectral index monitoring (BIS) as a guide for intubation without neuromuscular blockade in office-based pediatric general anesthesia: a retrospective evaluation.
abstract: The Bispectral Index System is a useful guide for timing of adequate intubation conditions in office-based pediatric general anesthesia without neuromuscular blockade. As the number of cases in the office-based setting increase, many clinicians opt to intubate patients without neuromuscular blockade to avoid airway complications associated with skeletal muscle relaxation. Conventionally, this technique is conducted using the traditional monitoring criteria of vital signs, end-tidal inhalation agents, as well as anesthesiologist timing and knowledge of the pharmacodynamics of the anesthetic agent to help determine the proper depth of anesthesia for adequate intubating conditions. This study retrospectively assesses the use of the Bispectral Index System (BIS) as a guide for timing of nonparalytic tracheal intubation in pediatric office-based general anesthesia. Anesthetic records for 168 children, American Society of Anesthesiology physical status I and II, and ranging in age from 18 months to 17 years were retrospectively analyzed. Intubation outcomes were based on 6 preset criteria to reflect the adequacy of the technique. The mean BIS value during the time of intubation was 34.7. There were no complications encountered. A BIS mean value of 34.7 provided adequate intubation conditions without muscle relaxation in office-based pediatric anesthesia without complications.
authors.affiliation: Associate Professor of Clinical Anesthesiology, University of Illinois Medical Center at Chicago, Department of Anesthesiology, Chicago, Illinois 60612, USA. messieha@uic.edu
authors.forename: Zakaria S
authors.initials: ZS
authors.lastname: Messieha
authors.forename: Samuel
authors.initials: S
authors.lastname: Guirguis
authors.forename: Sherine
authors.initials: S
authors.lastname: Hanna
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000553:Ambulatory Care; D000766:Anesthesia, Dental; D000768:Anesthesia, General; D000778:Anesthetics, Dissociative / Q000008:administration & dosage; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003729:Dental Care; D003770:Dental Offices; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007223:Infant; D007273:Injections, Intramuscular; D007442:Intubation, Intratracheal; D007649:Ketamine / Q000008:administration & dosage; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage; D008991:Monitoring, Physiologic; D019148:Neuromuscular Blockade; D011229:Preanesthetic Medication; D012189:Retrospective Studies; D000077149:Sevoflurane; D013997:Time Factors; D055986:Vital Signs
chemical_list: D000778:Anesthetics, Dissociative; D018685:Anesthetics, Inhalation; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D000077149:Sevoflurane; D007649:Ketamine; D008874:Midazolam