The utility of bispectral index monitoring for prevention of rocuronium-induced withdrawal movement in children

A randomized controlled trial

Research output: Contribution to journalArticle

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 5mg/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 0.6mg/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 6L/minute using sevoflurane 8% and then rocuronium was administered when BIS fell below 40 (the 2nd experimental group, group S; n=45). Rocuronium-inducedWMwas 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 ofWMwas 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. Conclusion: 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.

Original languageEnglish
Article numbere5871
JournalMedicine (United States)
Volume96
Issue number2
DOIs
Publication statusPublished - 2017 Jan 1

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Randomized Controlled Trials
Thiopental
Anesthesia
Hypnotics and Sedatives
Eyelashes
Breath Holding
Minor Surgical Procedures
Control Groups
Injections
Body Height
Premedication
rocuronium
Reflex
Body Mass Index
Arm
Extremities
Body Weight
Oxygen
Incidence

Keywords

  • Anesthesia
  • Anesthesia
  • Anesthetics
  • Bispectral index monitor
  • Children
  • General
  • Inhalation
  • Rocuronium
  • Sevoflurane
  • Thiopental

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{d8e7e1f1b0524e758e7924907fd263ad,
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 5mg/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 0.6mg/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 6L/minute using sevoflurane 8{\%} and then rocuronium was administered when BIS fell below 40 (the 2nd experimental group, group S; n=45). Rocuronium-inducedWMwas 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 ofWMwas 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. Conclusion: 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.",
keywords = "Anesthesia, Anesthesia, Anesthetics, Bispectral index monitor, Children, General, Inhalation, Rocuronium, Sevoflurane, Thiopental",
author = "Lim, {Byung Gun} and Lee, {Il Ok} and Kim, {Young Sung} and won, {young ju} and Heezoo Kim and Myounghoon Kong",
year = "2017",
month = "1",
day = "1",
doi = "10.1097/MD.0000000000005871",
language = "English",
volume = "96",
journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "2",

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TY - JOUR

T1 - The utility of bispectral index monitoring for prevention of rocuronium-induced withdrawal movement in children

T2 - A randomized controlled trial

AU - Lim, Byung Gun

AU - Lee, Il Ok

AU - Kim, Young Sung

AU - won, young ju

AU - Kim, Heezoo

AU - Kong, Myounghoon

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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 5mg/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 0.6mg/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 6L/minute using sevoflurane 8% and then rocuronium was administered when BIS fell below 40 (the 2nd experimental group, group S; n=45). Rocuronium-inducedWMwas 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 ofWMwas 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. Conclusion: 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.

AB - 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 5mg/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 0.6mg/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 6L/minute using sevoflurane 8% and then rocuronium was administered when BIS fell below 40 (the 2nd experimental group, group S; n=45). Rocuronium-inducedWMwas 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 ofWMwas 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. Conclusion: 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.

KW - Anesthesia

KW - Anesthesia

KW - Anesthetics

KW - Bispectral index monitor

KW - Children

KW - General

KW - Inhalation

KW - Rocuronium

KW - Sevoflurane

KW - Thiopental

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U2 - 10.1097/MD.0000000000005871

DO - 10.1097/MD.0000000000005871

M3 - Article

VL - 96

JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

SN - 0025-7974

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