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Inter-patient variability upon induction with sevoflurane estimated by the time to reach predefined end-points of depth of anaesthesia

Published online by Cambridge University Press:  27 January 2006

P. Lambert ,
E. Junke ,
T. Fuchs-Buder ,
C. Meistelman  and
D. Longrois
P. Lambert
Affiliation:
Centre Hospitalier Universitaire de Nancy, Department of Anaesthesia and Intensive Care, Hôpital Brabois,Vandoeuvre-les-Nancy, France
E. Junke
Affiliation:
Centre Hospitalier Universitaire de Nancy, Department of Anaesthesia and Intensive Care, Hôpital Brabois,Vandoeuvre-les-Nancy, France
T. Fuchs-Buder
Affiliation:
Centre Hospitalier Universitaire de Nancy, Department of Anaesthesia and Intensive Care, Hôpital Brabois,Vandoeuvre-les-Nancy, France
C. Meistelman
Affiliation:
Centre Hospitalier Universitaire de Nancy, Department of Anaesthesia and Intensive Care, Hôpital Brabois,Vandoeuvre-les-Nancy, France
D. Longrois
Affiliation:
Centre Hospitalier Universitaire de Nancy, Department of Anaesthesia and Intensive Care, Hôpital Brabois,Vandoeuvre-les-Nancy, France
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Summary

Background and objectives: A difficult issue in anaesthesia is its titration for an individual patient to avoid over- and underdosage. Common practice is to use an initial dose and increase it subsequently if the defined end-point is not reached. This assumes that the end-point is reached after a similar interval of time in all patients given a similar dose. In order to test this hypothesis we measured the time to reach end-points such as loss of consciousness (LOC), a bispectral index (BIS®) value of 60, the minimal BIS and the minimal mean arterial pressure (MAP) values. Methods: Thirty patients aged 18–60 yr scheduled for general surgery were included in this observational study. After preoxygenation, induction was performed with 6% inspired concentration of sevoflurane in 6 Lmin−1 oxygen using the SiBI® connector and the tidal volume technique. Remifentanil was administered when the BIS value was 60 and tracheal intubation was performed 4 min later. Results: Time (median, minimum–maximum) to LOC, a BIS value of 60, the minimal BIS and MAP values were, respectively, 75 (45–135), 120 (75–270), 300 (120–720) and 450 (120–1200) seconds. The time to the minimal BIS value was significantly (P < 0.05) shorter than the time to reach the minimal MAP value. Conclusions: These results demonstrate large inter-patient variability for the time necessary to reach defined end-points of depth of anaesthesia when a similar dose of anaesthetic is given. Measuring the time to reach a predefined BIS value would allow application of nociceptive stimuli only at adequate levels of hypnosis and would facilitate titration.

Keywords

ANAESTHESIA INHALATIONAL, sevoflurane, patient variationELECTROENCEPHALOGRAPHY, bispectral indexREMIFENTANIL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 4 , April 2006 , pp. 311 - 318
Copyright
© 2006 European Society of Anaesthesiology

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