Recovery of consciousness after thiopental or propofol : Bispectral index and the isolated forearm technique

• Published in: Anesthesiology (Philadelphia) Vol. 86; no. 3; pp. 613 - 619
• Main Authors: FLAISHON, R, WINDSOR, A, SIGL, J, SEBEL, P. S
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01-03-1997
• Subjects: Adult; Anesthesia, General - methods; Anesthetics, Intravenous - administration & dosage; Anesthetics, Intravenous - pharmacokinetics; Anesthetics. Neuromuscular blocking agents; Biological and medical sciences; Blood Pressure - drug effects; Blood Pressure - physiology; Consciousness; Electroencephalography - methods; Female; Forearm; Heart Rate - drug effects; Heart Rate - physiology; Humans; Male; Medical sciences; Monitoring, Physiologic - methods; Neuropharmacology; Pharmacology. Drug treatments; Propofol - administration & dosage; Propofol - pharmacokinetics; Thiopental - administration & dosage; Thiopental - pharmacokinetics; Time Factors; Electrodiagnosis; Vigilance; Thiopental sodium; Intravenous administration; General anesthetic; General anesthesia; Electroencephalography; Spectral index; Propofol; Barbiturates; Recovery
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/00000542-199703000-00013

Currently, there exists no effective monitor that can predict the probability of a patient being conscious during general anesthesia. The electroencephalogram-derived bispectral index (BIS) is a promising new method to assess anesthetic adequacy. This study used the BIS to predict the probability of recovery of consciousness after a single bolus induction dose of propofol or thiopental.
Twenty unpremedicated surgical patients were anesthetized with 4 mg/kg thiopental and 20 patients with 2 mg/kg propofol. The BIS was monitored throughout the study. After induction, before administration of neuromuscular blocking agent, a tourniquet was applied to one arm and inflated above the systolic blood pressure. This allowed preservation of the ability to move the hand after neuromuscular blocking agent onset. Patients were then prompted to squeeze the investigator's hand every 30 s, until they responded to the request. At the time of response, anesthesia was reinduced and the study terminated.
The BIS at loss of consciousness and recovery of a response was not statistically different between propofol and thiopental. No patient with a BIS less than 58 was conscious. In both groups, a BIS of less than 65 signified a less than 5% probability of return of consciousness within 50 s.
The BIS can be used to predict probability of recovery of consciousness after a single injection of either thiopental or propofol.