Background:Awareness during general anesthesia in different types of surgery is an important described adverse event. Bispectral (BIS) monitoring is one of the recent techniques proposed to monitor the depth of anesthesia.Objectives:The present study tested the hypothesis that the awareness rate and changes in hemodynamic parameters within anesthesia would be lower in patients allocated to BIS-guided management than those allocated to routine monitoring.Materials and MethodsIn total, 333 adult patients with the American Society of Anesthesiologists (ASA) physical status I-III, aged between 18 and 65 years scheduled for elective abdominal surgery under general anesthesia were included in this randomized double-blind placebo controlled trial. Patients were randomly allocated to BIS monitoring (n = 163) or routine monitoring (n = 170). BIS values and hemodynamic parameters including systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and SPO2 were marked before induction (control value), after intubation and laryngoscopy, at intubation, after incision, and also during the operation every 15 minutes until extubation.Results:The overall incidence of awareness in the BIS and routine monitoring groups were 5.5% and 4.1%, which was not significantly different. There were no significant differences in hemodynamic indices including SBP, DBP, HR, and SPO2 before induction of anesthesia between the two groups. These between-group differences in the studied indices remained insignificant at different time points after anesthesia induction as well as post ICU hospitalization. Furthermore, the trend of changes in hemodynamic parameters was comparable in the two groups.Conclusions:BIS-guided management may not be superior to routine monitoring protocols to prevent awareness as well as hemodynamic changes during general anesthesia in patients undergoing abdominal surgeries.
Background and Objective: Intubation is the most common method for the management of the upper airway in general anesthesia. In this regard, the prediction of the ease or difficulty of intubation is of paramount importance for the anesthesia team. The main cause of anesthesia-related mortality is failed airway management. The present study aimed to compare the accuracy of the upper lip bite (ULBT) test and mallampati test in the fast prediction of difficult intubation. Materials and Methods: This descriptive-analytical study was conducted on 418 patients. Prior to anesthesia, the degree of difficulty of intubation was predicted using two predictive tests, namely Mallampati test and upper lip bite test. In addition, after anesthesia, the degree of predicted difficulty was compared with the Cormack-Lehane classification of laryngoscopic view. Results: As evidenced by the obtained results, the frequency of difficult intubation was reported as 5.3%. Sensitivity, specificity, and negative predictive value of ULBT test were measured at 21.4%, 95.3%, and 97.2%, respectively. Moreover, the accuracy was obtained at 92.8% which was the highest value. On the other hand, sensitivity, specificity, and negative predictive value of Mallampati test were estimated at 34.7%, 87.5%, and 91%, respectively. In addition, the accuracy of this was reported as 81.3%. Conclusion: The results of the current study indicated that ULBT test as an easy method with high specificity, high predictive value, and high accuracy in the evaluation and prediction of difficult laryngoscopy is more suitable than Mallamati.
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