title: The utility of bispectral index monitoring for prevention of rocuronium-induced withdrawal movement in children: A randomized controlled trial.
abstract: BACKGROUND
  This study was designed to determine whether a deep hypnotic state with a bispectral index (BIS) value less than 40 could alleviate withdrawal movement (WM) upon rocuronium injection during anesthesia induction in children.
  
  
  METHODS
  Finally, 135 healthy children (3-12 years) scheduled for minor elective surgery were studied. Without premedication, anesthesia was induced with thiopental sodium 5 mg/kg. Patients were randomized into 2 groups (control vs experimental) and then by virtue of rocuronium injection time, patients in the experimental group were allocated into 2 groups, as follows: in the control group (group C; n = 45), rocuronium 0.6 mg/kg was administered at the loss of eyelash reflex; in the 1st experimental group, rocuronium 0.6 mg/kg was administered when BIS fell to less than 40 (group T; n = 45); however, if BIS did not fall below 40 after thiopental sodium administration, manual ventilation was provided with oxygen 6 L/minute using sevoflurane 8% and then rocuronium was administered when BIS fell below 40 (the 2nd experimental group, group S; n = 45). Rocuronium-induced WM was evaluated using a 4-point scale (no movement; movement/withdrawal involving the arm only; generalized response, with movement/withdrawal of more than 1 extremity, but no requirement for restraint of the body; and generalized response which required restraint of the body and caused coughing or breath-holding).
  
  
  RESULTS
  No significant differences were found among the groups for patient characteristics including age, sex, height, and location of venous cannula. However, body weight, height, and body mass index in group S were all smaller than those in group T. The incidence of WM caused by rocuronium was 100% in group C, 95.6% in group T, and 80% in group S, and was significantly lower in group S than in group C. The grade of WM was 3.7 ± 0.6 in group C, 3.2 ± 0.9 in group T, and 2.6 ± 1.0 in group S. It was significantly lower in group T than in group C and significantly lower in group S than in groups C and T.
  
  
  CONCLUSIONS
  The confirmation of a deep hypnotic state with BIS values lower than 40 using BIS monitoring can reduce the grade of rocuronium-induced WMs during anesthesia induction using thiopental sodium or sevoflurane in children.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Byung Gun
authors.initials: BG
authors.lastname: Lim
authors.forename: Il Ok
authors.initials: IO
authors.lastname: Lee
authors.forename: Young Sung
authors.initials: YS
authors.lastname: Kim
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Won
authors.forename: Heezoo
authors.initials: H
authors.lastname: Kim
authors.forename: Myoung Hoon
authors.initials: MH
authors.lastname: Kong
mesh_terms: D000732:Androstanols / Q000008:administration & dosage / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D056805:Consciousness Monitors; D006801:Humans; D007275:Injections, Intravenous; D016343:Monitoring, Intraoperative; D009068:Movement / Q000187:drug effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects*; D010146:Pain / Q000139:chemically induced / Q000517:prevention & control*; D000077123:Rocuronium
chemical_list: D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium