Tracheal intubation with volatile induction and target bispectral index of 25 versus 40: A randomized clinical trial.
OBJECTIVE
A target bispectral index (BIS) value of 40 is considered adequate for depth of anesthesia, but no consensus exists regarding BIS value for tracheal intubation without neuromuscular blocking drugs. The aim of this randomized, double-blinded study was to compare the total duration from sevoflurane induction to tracheal intubation at a BIS value of 25 or 40.


METHODS
This study was a prospective, randomized and observer-blinded clinical trial. After approval of the Institutional Ethics Committee and written informed consent, 80 patients of American Society of Anesthesiologists physical status I-II, aged 20-60 years, of either sex, requiring general anesthesia with tracheal intubation were enrolled. The patients were randomized to either Group BIS40-intubation at a target BIS value of 40 ± 5 or group BIS25-intubation at a target BIS value of 25 ± 5. The intubating conditions, hemodynamic, and adverse effects were observed in both the groups.


RESULTS
This study showed that the total time required from induction to tracheal intubation was 4.9 ± 0.9 min in group BIS40 as compared to 6.3 ± 0.5 min in group BIS25 (P = 0.001) using two-tailed sample t-test. The mean intubation score was 6.5 ± 0.9 in group BIS40, and 5.1 ± 0.7 in group BIS25 (P = 0.001) using Mann-Whitney U-test.


CONCLUSIONS
The time to achieve target BIS value of 25 was greater as compared to target BIS value of 40 during sevoflurane induction but provided better intubating conditions in the absence of neuromuscular agents.
Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.
Purva
P
Khandelwal
Department of Critical Care, INSCOL Hospital, Chandigarh, India.
Kanti Kumar
KK
Gombar
Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.
Vanita
V
Ahuja
Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India.
Satinder
S
Gombar
Bispectral index; inhalational induction; neuromuscular blockers; sevoflurane; tracheal intubation