Korean J Anesthesiol.  2011 Dec;61(6):460-464. 10.4097/kjae.2011.61.6.460.

The effect of pyridostigmine on bispectral index during recovery from sevoflurane anesthesia

• Jeong SJ
• Han JI
• Baik HJ
• Lee H
• Lee GY
• Kim JH

• KMID: 1854057
• DOI: http://doi.org/10.4097/kjae.2011.61.6.460

Abstract

BACKGROUND
There have been some conflicting reports showing that muscle relaxants and anticholinesterases affect the level of the bispectral index (BIS). The purpose of this study was to investigate whether pyridostigmine affects the level of the BIS during recovery from sevoflurane anesthesia.
METHODS
Fifty-two adult patients scheduled for laparoscopic cholecystectomy and laparoscopic appendectomy. Anesthesia was induced with thiopental 4 mg/kg and rocuronium 0.6 mg/kg. The lung was mechanically ventilated with 1-3 vol% sevoflurane, 50% oxygen and 50% nitrous oxide. After a specimen was removed, the sevoflurane concentration was maintained at 1.5 vol%. When skin closure began, sevoflurane was stopped; however, 50% oxygen and 50% nitrous oxide were maintained. The patients then received either (1) a group that received an injection of glycopyrrolate 0.04 mg/kg and pyridostigmine 0.2 mg/kg (reverse (R) group, n = 26) or (2) a group that received normal saline (control (C) group, n = 26). Group assignment was random. Pyridostigmine, a reversible cholinesterase inhibitor, is a parasympathomimetic. End-tidal sevoflurane concentration, train of four (TOF) ratio, bispectral index (BIS), blood pressure and heart rate were measured from the end of the operation to 15 min after inject of pyridostigmine or placebo.
RESULTS
There were no significant between group differences in the time dependent decrease in end-tidal sevoflurane concentration (P = 0.0642). There were significant differences between the two groups for the time course for increases in the TOF value (P < 0.0001). There were significant differences between the two groups for the time course for increases in the BIS value (P = 0.0107). There were no significant differences in the mean BIS value up to 10 minutes after administering drug, but 15 minutes after administrating the reverse drug or the control drug, the BIS value showed significantly different BIS values: 68.2 +/- 6.2 (Group R) and 63.2 +/- 6.2 (Group C) (P = 0.0058).
CONCLUSIONS
The finding that pyridostigmine increases TOF and BIS suggests that pyridostigmine may enhance recovery during recovery from sevoflurane anesthesia.

Keyword

Bispectral index; Pyridostigmine; Sevoflurane; TOF ratio

MeSH Terms

Adult
Androstanols
Anesthesia
Appendectomy
Blood Pressure
Cholecystectomy, Laparoscopic
Cholinesterase Inhibitors
Cholinesterases
Glycopyrrolate
Heart Rate
Humans
Lung
Methyl Ethers
Muscles
Nitrous Oxide
Oxygen
Pyridostigmine Bromide
Skin
Thiopental
Androstanols
Cholinesterase Inhibitors
Cholinesterases
Glycopyrrolate
Methyl Ethers
Nitrous Oxide
Oxygen
Pyridostigmine Bromide
Thiopental