Publication:

Haemodynamic stability and incidence of adverse events during tracheal intubation without neuromuscular blockade: comparison of clinical versus bispectral-index monitored depth of anaesthesia

Background Haemodynamic stability during intubation is influenced by sympathetic response to laryngoscopy and intubation. Furthermore, the incidence of adverse events during intubation without NMB warrants further investigation. BIS-guided anaesthesia has been associated with improved haemodynamic outcomes compared to clinical monitoring alone. Despite these advantages, the utility of BIS monitoring during intubation without NMB remains underexplored.

Methods This was a randomised, single-blind, controlled clinical study conducted in the Jos university teaching hospital, Jos, Nigeria, among 56 children aged 2 to 6 years with ASA I and II scheduled for adenotonsillectomy. Patients were randomised into two groups, B and C, with patients in group B receiving BIS monitoring while those in group C received clinical monitoring for the depth of anaesthesia with sevoflurane and without a neuromuscular blocking agent. Haemodynamic changes and adverse events associated with laryngoscopy were noted. Data was analysed using SPSS with students’ t test and chi-square test being the statistical tests utilised, and the level of significance set at p=0.05.

Results Systolic blood pressures were slightly higher in group C than group B. Diastolic blood pressures were slightly higher in group B than group C, while differences in mean arterial pressure between group B and group C were not statistically significant (p=0.10). Adverse events were only found in group C, with 10.7% of patients developing laryngospasm.

Conclusions The monitoring of inhalational induction using clinical signs is an acceptable alternative to BIS and can be used in the absence of BIS.