Bispectral Index and Hemodynamic and Catecholamine Responses to Intubation during Target-Effect Site-Controlled Infusion of Propofol with Fentanyl Coadministration

Baik, Hee Jung; Kim, Yun Jin; Kim, Jong Hak

Abstract

BACKGROUND: We evaluated bispectral index (BIS) and hemodynamic and catecholamine responses to induction and intubation at different effect site concentrations during the target-effect site-controlled infusion of propofol with fentanyl coadministration.
METHODS
Thirty patients scheduled for elective surgery under general anesthesia were randomly assigned to two groups. Anesthesia was induced using the target-effect site-controlled infusion of propofol at different effect site concentrations (Group I: 3.0microgram/ml, Group II: 3.5microgram/ml) following bolus injection of fentanyl (2microgram/kg). We measured BIS and systolic, diastolic, and mean arterial blood pressures, heart rate, epinephrine (E), and norepinephrine (NE) 5 min before induction, at loss of consciousness, just before intubation, immediately after intubation, and 1, 2, and 3 minutes after intubation.
RESULTS
No significant differences were observed in hemodynamic or catecholamine responses to induction or intubation between the two groups. In both groups, hemodynamic changes to induction and intubation were within 30% and 20% of pre-induction levels, respectively, and catecholamine responses significantly decreased or did not change versus pre-induction levels. But in group II, the dose of propofol administered was significantly more than in group I, and BIS levels immediately before and after intubation were below 40.
CONCLUSIONS
With fentanyl coadministration of 2microgram/kg, targeting 3.0microgram/ml as an effect site concentration of propofol during target-effect site-controlled infusion is better than targeting 3.5microgram/ml, because targeting the latter produced too low a BIS and too much propofol administration, although both targeted values produced similar hemodynamic and catecholamine responses.