Saudi Journal of Anaesthesia

EDITORIAL
Year
: 2013  |  Volume : 7  |  Issue : 1  |  Page : 1--2

Clinical or technological evaluation of depth of anesthesia at induction time: A simple study for an easy message


Péan Didier1, Lejus Corinne2,  
1 Hôtel Dieu Hôpital Mère Enfant, CHU De Nantes, Service d' Anesthésie et de Réanimation Chirurgicale, Place Alexis Ricordeau, Nantes, F-44093, France
2 Hôtel Dieu Hôpital Mère Enfant, CHU De Nantes, Service d' Anesthésie et de Réanimation Chirurgicale, Place Alexis Ricordeau, Nantes, F-44093; Université de Nantes, Faculté de Médecine, 1 Rue Gaston Veil, Nantes, F-44000, France

Correspondence Address:
Péan Didier
Hôtel Dieu Hôpital Mère Enfant, CHU De Nantes, Service d«SQ» Anesthésie et de Réanimation Chirurgicale, Place Alexis Ricordeau, Nantes, F-44093
France




How to cite this article:
Didier P, Corinne L. Clinical or technological evaluation of depth of anesthesia at induction time: A simple study for an easy message.Saudi J Anaesth 2013;7:1-2


How to cite this URL:
Didier P, Corinne L. Clinical or technological evaluation of depth of anesthesia at induction time: A simple study for an easy message. Saudi J Anaesth [serial online] 2013 [cited 2020 Apr 3 ];7:1-2
Available from: http://www.saudija.org/text.asp?2013/7/1/1/109551


Full Text

At the time where technology applied to anesthesia is securing more and more our daily practice with an evolution to less death and complications, Veena Asthana et al. have performed an original study about clinical appreciation of induction depth of anesthesia: "Clinical vs. bispectral index-guided propofol induction of anesthesia. [1],[2]

Many studies have demonstrated the superiority of technology over clinical appreciation in many fields of our practice. Acceleromyographic monitoring of residual neuromuscular block antagonisation is better than clinical evaluation, target-controlled is better than manually-controlled infusions of propofol for intubation under spontaneous breathing anesthesia; the use of a hand-held manometer is better than digital palpation of the pilot balloon to assess the intra-cuff pressure of tracheal tubes, etc. [3],[4],[5]

The originality of the study of Veena Asthana et al. is to demonstrate that the dosing of propofol for anesthesia induction is similar whether they use loss of verbal control or Bispectral Index of electroencephalogram (BIS) monitoring as reference. [1] BIS level was comparable in both groups at intubation time.

The need to optimize drug administration during anesthesia is now well recognized and tracheal intubation time is a critical while. The first concern is for hemodynamic stability: In the example, the results of a recent study confirm that the duration of a 30% reductions in mean blood pressure from baseline, was associated with postoperative stroke in patients undergoing non-cardiac, non-neurosurgical surgery. [6] In Veena Asthana et al. study, no difference was recorded in heart rate and non-invasive arterial pressure value between clinical and BIS groups. The variations between pre-induction and post intubation time where clinically insignificant.

The second concern is the risk of memorization. In the Veena Asthana et al. study the BIS value at intubation time was 52.91±11.04 in clinical group and 53.43±7.60 in BIS group. [1] With or without BIS monitoring the values are in a good range to limit this complication.

The third concern is to coordinate drugs effect site peak concentration at intubation time (hypnotic, curare and morphinomimetic): This is the key for a successful and less traumatic tracheal access. At least, I want to precise that continuous target controlled administration of propofol is a good alternative to manual infusion, especially when intubation is difficult. This is the best option to maintain a sufficient anesthesia depth during airway management. [7] But, here is exactly one of the methodological limitation of the Veena Asthana et al. study: The authors don't include the monitoring of curarization in the study. The other limitation is the young ASA 1-2 population of patients (34.17±10.54 years in clinical group and 32.69±12.70 in BIS group): Indeed, the message of is this study is limited to this range of patients.

In conclusion, the authors demonstrate with a simple study that BIS monitoring is not necessary for induction in a young population of patients. It is important to know the limitation of technology applied to anesthesia. Of course, it remains now impossible to circumvent this helps to clinical appreciation in anesthesia daily practice.

References

1Arya S, Asthana V, Sharma JP. Clinical vs. bispectral index-guided propofol induction of anesthesia: A comparative study. Saudi J Anaesth 2013;7:75-9.
2Lienhart A, Auroy Y, Péquignot F, Benhamou D, Warszawski J, Bovet M, et al. Survey of anesthesia-related mortality in France. Anesthesiology 2006;105:1087-97.
3Baillard C. Incidence and complications of post operative residual paralysis. Ann Fr Anesth Reanim 2009;28:S41-5.
4Passot S, Servin F, Allary R, Pascal J, Prades JM, Auboyer C, et al. Target-controlled versus manually-controlled infusion of propofol for direct laryngoscopy and bronchoscopy. Anesth Analg 2002;94:1212-6.
5Faris C, Koury E, Philpott J, Sharma S, Tolley N, Narula A. Estimation of tracheostomy tube cuff pressure by pilot balloon palpation. J Laryngol Otol 2007;121:869-71.
6Bijker JB, Persoon S, Peelen LM, Moons KG, Kalkman CJ, Kappelle LJ, et al. Intraoperative hypotension and perioperative ischemic stroke after general surgery: A nested case-control study. Anesthesiology 2012;116:658-64.
7Sztark F, Francon D, Combes X, Hervé Y, Marciniak B, Cros AM. Which anaesthesia techniques for difficult intubation? Particular situations: Question 3. Société Française d'Anesthésie et de Réanimation. Ann Fr Anesth Reanim 2008;27:26-32.