# Abstract

 

## BACKGROUND: Induction of anesthesia is the most crucial period of general anesthesia. Inhalational induction is the most commonly used technique in pediatric anesthesia. Tracheal intubation can be done after reaching the deep levels of anesthesia. The depth of anesthesia is often difficult to be judged. Bispectral index is a measure of the effects of anesthesia on brain. This study was designed to evaluate the efficacy of bispectral index (BIS) in clarifying suitable depth of anesthesia for tracheal intubation during inhalational induction of anesthesia. 

## METHODS: In a clinical trial, ninety patients, ASA I & II, 1 to 6 years old, scheduled for elective surgery were enrolled into the study. After starting BIS monitoring, patients randomly were divided into three groups. Then, anesthesia was induced by gradual increase of halothane in 50% mixture of oxygen (O ~2~ ) and N ~2~ O and continued until target BIS (60 ± 2, 50 ± 2 and 40 ± 2) achieved. After tracheal intubation, the duration of laryngoscopy and the presence of laryngospasm, bronchospasm, laryngoscopy failure, the movement of extremities and the changes in SpO2 and BIS were recorded. The data were analyzed by chi-square and ANOVA at 0.05 level of significance. 

## RESULTS: BIS could not determine the appropriate level of anesthesia for tracheal intubation in this setting. There were no differences in laryngoscopy duration and the occurrence of laryngospasm, bronchospasm, laryngoscopy failure, extremity movement and awakening time among three groups. 

## CONCLUSIONS: These results confirmed that there was no significant difference in the incidence of complications related to intubation at different BIS values (from 60 to 40) during inhalation induction, and probably to achieve an adequate or more reliable depth of anesthesia, the lower values of BIS is required. # Results Ninety patients including 25 females and 65 males were enrolled into the study. Mean and standard deviation of age and weight were 2.82±1.25 years and 12.13±2.86 kg, respectively (P>0.05). The mean and SD of age in groups 1 to 3 were 2.77±1.4, 2.53±1.4 and 3.18±0.8, respectively with the p value of 0.122; and these measures for weight were 12.33±2.6, 11.87±3.4 and 12.18±2.6, respectively and the p value for this variable was 0.823. The relative distribution of male/female ration in groups 1, 2, and 3 were 21/9, 22/8 and 22/8, respectively (P = 0.946). There were no significant differences in laryngoscopy duration, laryngospasm, bronchospasm, laryngoscopy failure, extremity movement, awakening time among three groups. (p\<0.05) (Tables [1](#) and [2](#) ). ::::table-wrap

::: caption
Comparison of time to reach to proposed bispectral index (BIS), duration
of laryngoscopy, mean changes of BIS, heart rate, arterial oxygen
saturation (SpO2), end tidal CO2 (EtCO2) and an awakening time among
three groups
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![](<>):::: ::::table-wrap
::: caption
The frequency distributions of responses to laryngoscopy among three
groups
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![](<>):::: In addition to our findings, it was unpredictably seen that groups who had a lower BIS values (group 2 and 3) showed a significant increase in BIS values due to the laryngoscopic stimuli ( [Table-3](#) ). ::::table-wrap
::: caption
The mean bispectral index (BIS) before and immediately after intubation
in different groups
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Extracted trial result:
Outcome: laryngoscopy failure (continuous)
Intervention: group 1 included bispectral index (BIS) of 60, group 2 covered bispectral index (BIS) of 48
Comparator: group 3 involved bispectral index (BIS) of 38
Intervention group size: 60
Comparator group size: 30
Notes: mean and std not given for group 1 and 2 combined