title: Light levels of anaesthesia after relaxation for tracheal intubation - comparison of succinylcholine and cis-atracurium.
abstract: BACKGROUND
  Use of a single bolus of a hypnotic together with non-depolarizing muscle relaxants for anaesthesia induction may cause inappropriate light levels of anaesthesia (ILLA). The purpose of this study was to compare the incidence of ILLA during anaesthesia induction using either cis-atracurium (CIS) or succinylcholine (SUC).
  
  
  METHODS
  Patients (n = 65) received fentanyl and propofol. Relaxants were randomly chosen and were either CIS 0.15 mg/kg, or SUC 1 mg/kg. After achieving relaxation, ILLA were assessed double-blinded by the isolated forearm technique and electroencephalogram -derived values.
  
  
  RESULTS
  Time from induction to complete relaxation was 335 ± 55 s with CIS and 141 ± 26 s with SUC. Nine patients in the CIS group (26%), but no patient in the SUC group responded to commands before endotracheal intubation (P < 0.01). During the entire induction up to 1 min after intubation in the CIS group, 24 of 35 patients (68%) showed 31 episodes of ILLA, as defined as responsiveness to commands and spontaneous movements. With SUC, 8 of 30 patients (27%) showed 11 episodes of ILLA (P < 0.01). In patients with ILLA, state entropy (SE) and spectral edge frequency (SEF) were 68 ± 10 (mean ± standard deviation) and 17 ± 4 Hz, respectively, and in patients without ILLA, SE and SEF were 40 ± 14 and 12 ± 3 Hz, respectively (P < 0.01).
  
  
  CONCLUSIONS
  The onset time of a muscle relaxant has substantial impact on the incidence of ILLA during induction of anaesthesia. Entropy and SEF may indicate the presence of ILLA.
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Diako Hospital, Flensburg, Academic Teaching Hospital of the University of Kiel, Germany. linstedtul@diako.de
authors.forename: U
authors.initials: U
authors.lastname: Linstedt
authors.forename: K G
authors.initials: KG
authors.lastname: Haecker
authors.forename: A W
authors.initials: AW
authors.lastname: Prengel
mesh_terms: D000328:Adult; D000758:Anesthesia; D018686:Anesthetics, Intravenous; D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004311:Double-Blind Method; D004569:Electroencephalography / Q000187:drug effects; D023381:Endpoint Determination; D019277:Entropy; D005260:Female; D006801:Humans; D058926:Intraoperative Awareness / Q000517:prevention & control*; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D010812:Physical Stimulation; D015742:Propofol; D013390:Succinylcholine / Q000008:administration & dosage*
chemical_list: D018686:Anesthetics, Intravenous; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D013390:Succinylcholine; C101584:cisatracurium; D015742:Propofol