Effects of preanesthetic single administration of dexmedetomidine on the remifentanil and propofol requirement during laparoscopic cholecystectomy

BACKGROUND: Dexmedetomidine, an α2-adrenergic agonist, can be used for sedation and as an adjuvant to anesthetics. This study aimed to evaluate the effects of preanesthetic administration of dexmedetomidine on the propofol and remifentanil requirement during general anesthesia and postoperative pain in patients undergoing laparoscopic cholecystectomy. METHODS: Sixty patients were randomly assigned to group D or S (n = 30 each). Dexmedetomidine (0.5 µg/kg) and a comparable volume of saline were administered in groups D and S, respectively, over a 10 minutes period before induction. General anesthesia was induced and maintained with propofol and remifentanil; the bispectral index was maintained at 40–60. The intraoperative remifentanil and propofol dosages were recorded, and postoperative pain was assessed using a visual analog scale (VAS). RESULTS: In groups S and D, propofol dosage was 8.52 ± 1.64 and 6.83 ± 1.55 mg/kg/h, respectively (P < 0.001), while remifentanil dosage was 7.18 ± 2.42 and 4.84 ± 1.44 µg/ kg/h, respectively (P < 0.001). VAS scores for postoperative pain were 6.50 (6–7) and 6.0 (6–7), respectively, at 30 minutes (P = 0.569), 5 (4–5) and 4 (3–5), respectively, at 12 hours (P = 0.039), and 2 (2–3) and 2 (1.25–2), respectively, at 24 hours (P = 0.044). The Friedman test revealed that VAS scores changed over time in both groups (P < 0.001). CONCLUSIONS: Preanesthetic single administration of a low dose of dexmedetomidine (0.5 µg/kg) can significantly decrease the remifentanil and propofol requirement during short surgeries and alleviate postoperative pain.

Relationship of preoperative echocardiography and circulation in living donor liver transplantation

BACKGROUND: Echocardiography has been routinely performed before liver transplantation to screen perioperative risks due to cardiovascular complications. However, only limited echocardiographic indices have been used and have become familiar with clinicians. Here we aimed to evaluate the relationship between preoperative echocardiography and circulatory manifestations during living donor liver transplantation (LDLT). METHODS: Perioperative data including preoperative echocardiographic indices and intraoperative circulatory manifestations from 159 LDLT recipients (> or =18 years) were retrospectively collected. Relationships between individual echocardiographic indices and intraoperative circulatory manifestations were assessed by Pearson or Spearman correlation test. Intraoperative circulatory manifestations showing potential correlation with echocardiographic indices (r > or = 0.2 or or = 0.5 or < or =-0.5) were not found between echocardiographic indices and intraoperative circulatory manifestations, but intensive vasopressor coverage, urine output, sodium bicarbonate administration and last blood pH showed potential relations with at least one of preoperative echocardiographic indices. Early and late (atrial) ventricular filling velocity (E/A) ratios were lower in recipients with intensive vasopressor coverage, and left atrial diameter (LAD) were larger in recipients with last blood pH < 7.25. However, other parts of echocardiographic indices showed inconsistent relationships with formerly prevalent knowledge. CONCLUSIONS: Preoperative echocardiographic indices such as E/A ratio and LAD showed relationship with circulatory manifestations during LDLT. However, low correlation degrees and lack of evidence in reverse relationship with circulatory manifestations demands further studies focusing on such specific cardiac function.

Botulinum toxin type A therapy in cluster headache: A case report

Cluster headache is a severe pain syndrome with a piercing, tearing sensation, nicknamed the suicide headache. It is associated with an autonomic symptom. No effective therapy is available in approximately 4-15% of patients with cluster headache. One of the treatment methods is occipital nerve block. It is conventionally performed with local anaesthetics, and in this case we used the botulinum toxin type A. Botulinum toxin is an effective therapeutic agent for various disorders, and has recently been discovered to be an effective treatment for chronic migraine. The efficacy of Botulinum toxin in headache invokes possible neurogenic effects that may reduce or even prevent sensitization of both the peripheral and central nervous system. Therefore, we describe a case of a 45-year-old male with a cluster headache that could not be controlled with conventional therapy. We performed botulium toxin type A therapy. Cluster headache VAS showed improvement after occipital nerve block using the botulinum toxin A.

Pain managements in pancreatic cancer patient with opioid-induced hyperalgesia: A case report

Opioids are generally used to treat severe cancer pain. Usually, it is common to increase the dose of opioids to maintain analgesia. Opioid-induced hyperalgesia (OIH) is a paradoxical response to opioid resulting in increased perception of pain rather than antinociceptive effect. A 64-year-old female with pancreatic cancer was suffering from whole abdominal pain. She took massive opioid therapy, however, her pain had been worse and widen in the 3 months. Radiologic imaging was performed to exclude metastatic cancer. The result was negative. We suspected OIH, and reduced the amount of opioids, then, added to adjuvant analgesics. And also we performed celiac plexus neurolysis with the use of alcohol and continuous epidural catheter insertion. Her numeric rating pain scale (NRS) decreased from 9/10 to 3/10. This case suggests that adjuvant analgesics and interventional treatments can resolve a OIH patient with intractable cancer pain.

Anesthetic management with propofol/remifentanil target controlled infusion for awake craniotomy: A case report

Awake craniotomy is indicated for tumor resection involving eloquent cortex. It allows the operator to perform appropriate cortical mapping during surgery and facilitate maximum tumor resection while minimizing neurologic deficit. Therefore anesthesia should provide adequate analgesia and sedation but also importantly a full consciousness and cooperation for neurologic testing. This case reports the use of target-controlled infusion (TCI) and monitoring of sedation and anesthetic depth through bispectral index (BIS), providing good control of sedation and analgesia to meet frequent changes throughout the different levels of the procedure while maintaining good condition for intraoperative brain mapping. We propose that TCI of propofol and remifentanil in combination may be a useful alternative for awake craniotomy requiring intraoperative brain mapping surgery.

Blood coagulation changes in laparoscopic gastrectomy: morbid obese vs normal patients

BACKGROUND: Patients with morbid obesity have higher risk of fatal thromboembolic episodes than non-obese patients. We aimed to identify perioperative changes in blood coagulation for the patients undergoing bariatric surgery and compare thromboelastography (TEG) findings with non-obese patients. METHODS: 24 patients with morbid obesity (group B) and 22 patients with stomach cancer (group S) who undergoing laparoscopic Roux-en-Y gastric bypass surgery were prospectively studied. Laboratory coagulation-related tests and TEG were conducted immediately after anesthetic induction (T0), at 2 hours after surgical incision (T1), and 2 hours after the end of surgery (T2). RESULTS: Group B had higher serum lactate, fibrinogen, maximum amplitude in TEG findings, and shorter activated partial thromboplastin time (aPTT) than group S at T0 (P < 0.05). In group B, serum fibrinogen degradation products (FDP) at T2 and base deficit at T1 and T2 were higher, and aPTT was shorter than those at T0 (P < 0.05). R-time and k-time showed gradual shortening toward T2. alpha-angle at T1 and coagulation index at T2 increased significantly from those at T0 in the group B (P < 0.05). However, group B failed to show any significant differences from the group S in TEG and coagulation-related laboratory findings except platelet count and serum fibrinogen level at T1 and T2. CONCLUSIONS: Preoperatively, morbidly obese patients had more activated coagulation profiles than non-obese patients. However, remarkable perioperative changes in TEG findings could not be definitely observed between two groups.

The optimal concentrations of propofol at eye opening and orientation after propofol-remifentanil TCI in Koreans

BACKGROUND: The recovery time in propofol target controlled infusion (TCI) can be determined by the context sensitive decrement time (CSDT) using a Multichannel TCI system. Therefore, it is important to obtain the default CSDT in a Multichannel TCI system. The effect-site concentrations for eye opening and orientation in adults after propofol-remifentanil TCI were evaluated according to the CSDT using a Multichannel TCI system. METHODS: After obtaining informed consent and Institutional Review Board approval, 135 ASA Class I or II patients scheduled to undergo elective surgery were divided into 3 groups according to age. The three groups included the following: group 1 (n = 45), 18-19 years; group 2 (n = 45), 30-39 years; and group 3 (n = 45), 40-54 years. The propofol infusion was started at a propofol target effect-site concentration (CeT) of 6microg/ml. Anesthesia was maintained primarily with a propofol CeT of 2.5microg/ml, a remifentanil CeT of 6ng/ml and with 67% nitrous oxide in oxygen. The average effect-site concentrations of propofol at eye opening and orientation in each group were estimated. RESULTS: The average range of the effect-site concentrations of propofol at eye opening and orientation after surgery were 0.9-1.1microg/ml. The range of times to eye opening and orientation after stopping the nitrous oxide and infusion after surgery were 10.9-12.9 min. CONCLUSIONS: The average range of the effect-site concentrations of propofol at eye opening and orientation after propofol-remifentanil TCI in Koreans are 0.9-1.1microg/ml.

The optimal concentrations of propofol at eye opening and orientation after propofol-remifentanil TCI in Koreans

BACKGROUND: The recovery time in propofol target controlled infusion (TCI) can be determined by the context sensitive decrement time (CSDT) using a Multichannel TCI system. Therefore, it is important to obtain the default CSDT in a Multichannel TCI system. The effect-site concentrations for eye opening and orientation in adults after propofol-remifentanil TCI were evaluated according to the CSDT using a Multichannel TCI system. METHODS: After obtaining informed consent and Institutional Review Board approval, 135 ASA Class I or II patients scheduled to undergo elective surgery were divided into 3 groups according to age. The three groups included the following: group 1 (n = 45), 18-19 years; group 2 (n = 45), 30-39 years; and group 3 (n = 45), 40-54 years. The propofol infusion was started at a propofol target effect-site concentration (CeT) of 6microg/ml. Anesthesia was maintained primarily with a propofol CeT of 2.5microg/ml, a remifentanil CeT of 6ng/ml and with 67% nitrous oxide in oxygen. The average effect-site concentrations of propofol at eye opening and orientation in each group were estimated. RESULTS: The average range of the effect-site concentrations of propofol at eye opening and orientation after surgery were 0.9-1.1microg/ml. The range of times to eye opening and orientation after stopping the nitrous oxide and infusion after surgery were 10.9-12.9 min. CONCLUSIONS: The average range of the effect-site concentrations of propofol at eye opening and orientation after propofol-remifentanil TCI in Koreans are 0.9-1.1microg/ml.

The effects of magnesium pretreatment on reperfusion injury during living donor liver transplantation / 대한마취과학회지

BACKGROUND: Ischemia reperfusion (IR) injury is a complex phenomenon that leads to organ dysfunction and causes primary liver failure following liver transplantation. We investigated whether an intravenous administration of magnesium before reperfusion can prevent or reduce IR injury. METHODS: Fifty-nine living donor liver transplant recipients were randomly assigned to an MG group (n = 31) or an NS group (n = 28). Each group was also divided in two groups based on the preoperative magnesium levels (normal: > or = 0.70 mmol/L, low: < 0.70 mmol/L). The MG groups received 25 mg/kg of MgSO4 mixed in 100 ml normal saline intravenously before reperfusion and the NS groups received an equal volume of normal saline. The levels of lactate, pH, arterial oxygen tension, and base excess were measured to assess reperfusion injury at five specific times, which were 10 min after the beginning of anhepatic phase, and 10, 30, 60 and 120 min after reperfusion. To evaluate postoperative organ function, the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin and creatinine levels were measured at preoperative day 1, postoperative day 1 and 5. RESULTS: The blood lactate levels were significantly lower at 10, 30, 60 and 120 min after reperfusion in the MG groups compared to the NS groups. In addition, significantly higher blood lactate levels were observed in the NS group with preoperative hypomagnesemia than in MG groups. CONCLUSIONS: Magnesium administration before reperfusion of liver transplantation significantly reduces blood lactate levels. These findings suggest that magnesium treatment may have protective effects on IR injury during living donor liver transplantation.

A case of transient paraplegia following celiac plexus block with alcohol: A case report

A 61-year-old man who had cholangiocarcinoma with multiple metastasises was referred to our hospital for his pain control.Celiac plexus block with 99.9% alcohol was performed by the retrocrural approach under fluoroscopic guidance.Examination of the patient at fifteen minutes after successfully performing the diagnostic block showed no sensory or motor change.Forty-eight hours after the neurolysis, the patient's lower extremities were totally paralyzed, and he could not walk nor control his anal sphincter.But thereafter he progressively recovered.Five days after celiac plexus neurolysis, he was able to walk with support from one hand.Reversible ischemia of the spinal cord due to damage to the Adamkiewicz arterial blood supply was thought to be the cause.

Effect of remifentanil on tumor necrosis factor-alpha and interleukin-6 responses in patients undergoing laparoscopic hysterectomy

BACKGROUND: Cytokines are important mediators of immune response to surgery and pain.The aim of the study was to investigate the effect of remifentanil on serum levels of cytokines, tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6), in patients undergoing laparoscopic hysterectomy. METHODS: Twenty four patients scheduled for laparoscopic hysterectomy were randomly assigned to control or remifentanil group.Both groups received 1.5-2.5% end tidal concentration of sevoflurane and air in 50% oxygen.Remifentanil group received a bolus of remifentanil 1microgram/kg over 1 min and an infusion of remifentanil at a rate of 0.1microgram/kg/min.Control group received 10 ml saline (placebo) and an infusion of saline at the same rate. Venous blood samples for measurement of serum cytokine concentrations were taken before anesthesia (T1), at 2 h after infusion (T2), and at the 1 hour after surgery (T3). RESULTS: Serum TNF-alpha concentration did not differ significantly over time in both groups.Serum TNF-alpha concentration was higher in remifentanil group at T3 (9.76 +/- 1.19 pg/ml vs.8.53 +/- 0.71 pg/ml) than in control group (P < 0.05). In both groups, serum IL-6 concentrations were significantly higher at T3, when compared to those at T1 and T2 (P < 0.05). CONCLUSIONS: Remifentanil did not attenuate early postoperative change of serum TNF-alpha and IL-6 concentrations in patients undergoing laparoscopic hysterectomy. Serum IL-6 level increased at postoperative 1 h, regardless of remifentanil use.

Effect of 1 mg of prophylactic haloperidol for postoperative nausea and vomiting after gynecological laparoscopic surgery using IV patient controlled analgesia

BACKGROUND: Haloperidol, a major tranquilizer similar to droperidol, has been found to have a potent antiemetic effect on postoperative nausea and vomiting (PONV), but the supporting evidence was incomplete, especially in Korea.Therefore we evaluated the prophylactic effect of haloperidol on opioid-based IV patient-controlled analgesia (PCA) related PONV in susceptible patients after gynecological laparoscopic surgery. METHODS: Ninety-six adult women scheduled gynecological laparoscopic surgery were enrolled in a randomized, double-blinded and placebo study.Patients received haloperidol 1 mg (Group H) or saline (Group C) 30 min before the end of surgery.Fentanyl-based IV PCA was administered after surgery.The incidences and severity of nausea, vomiting, rescue antiemetic administration, pain, and adverse effects (cardiac arrhythmias and extrapyramidal effects) were assessed for 24 h after surgery.The sedation score was recorded in the post-anesthesia care unit for 2 h. RESULTS: The incidences and severity of nausea and the number of antiemetic administration were significantly lower in Group H than Group C (P < 0.05). But the sedation and pain score were similar. There was no QTc prolongation or extrapyramidal symptom in both groups. CONCLUSIONS: Prophylactic haloperidol 1 mg is effective in preventing PONV related to fentanyl-based IV PCA, with less adverse effects, in patients undergoing gynecological laparoscopic surgery.

Prolonged effect of nicardipine used for deliberate hypotension in scoliosis surgery: A case report

Postoperative respiratory complications following scoliosis surgery are high incidence. In this case, fifty year-old male patient was admitted for thoracolumbar screw fixations and developed postoperative pulmonary edema. This was most likely due to prolonged administration of nicardipine, which over time may inadvertently cause hypotension. As a result of volume overload, interstitial pulmonary edema and pleural effusion occurred. Moreover, pulmonary edema and pleural effusion appeared on the right side first and spread to the left. This phenomenon could be explained by the positioning of scoliosis patient. The cause of pulmonary edema was volume overload initiated by prolonged effect of nicardipine.

Comparative acute toxicity of quaternary ammonium lidocaine derivative QX-314 to lidocaine in mice

BACKGROUND: The current study examined the acute systemic toxicity of QX-314 that there have been few research results for this so far. In order to be useful as a drug, it must be shown to have minimal toxicities. Hence, we compared the CNS and cardiac toxicities of QX-314 to the conventional local anesthetic lidocaine. METHODS: Acute toxicity was evaluated by determining the individual intravenous CD50 and LD50 of QX-314 and lidocaine. There were four doses for each LD50 determination and 8 animals per dose level. Animals were observed for several hours immediately following drug administration and recorded overt effects and fatalities. Both lidocaine and QX-314 were dissolved in saline. Lidocaine and QX-314 were diluted to 1, 2, 4, 6 and 0.5, 1, 2, 4%, respectively with saline and injected at the same volume to minimized cardiovascular effect. RESULTS: The intravenous CD50 and LD50 were 12.7 and 14.1 mg/kg for QX-314 and 15.7 and 28.8 mg/kg for lidocaine. Electrocardiograms showed intraventricular block (widened QRS complex) at high doses of lidocaine compared to AV block (loss of QRS complex) at high concentrations of QX-314. There are no evidence that CNS toxicity led mouse to death. CONCLUSIONS: QX-314 is about 1.5 times as toxic as lidocaine. Although QX-314 may still be useful clinically as a long-lasting local anesthetic, its safety relative to other available local anesthetics must be considered.

Extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever with respiratory failure : A case report

Multiple myeloma can usually be identified by non-traumatic vertebral fracture or signs of recurrent infection. Without these clinical signs, detection is unlikely. We briefly report a case of extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever. In doing so, we highlight the importance of subtle changes in laboratory findings. A 67-year-old man presented with spontaneous acute epidural hematoma, and hematoma evacuation was performed at the same site 3 times. A radiologic work-up failed to reveal any osseous lesions and he made a gradual recovery. In the meantime, he suffered unexplained fever up to 39oC despite normal chest and abdominal radiograms. Blood chemistry showed mild leukocytosis, high ESR and CRP, and a slightly elevated globulin. On his 15th hospital day, immunoglobulin studies confirmed the diagnosis of multiple myeloma. He was treated in the ICU for difficult breathing and uncontrolled fever. In spite of intensive critical care, his leukocyte count fell to below 2,000 and he died on postoperative day 28. Apparently normal laboratory and radiologic findings can hamper swift discovery and ultimate management of multiple myeloma. When there is unexplained repeated intracranial bleeding and accompanying fever, the possibility of hidden malignancy should be assessed to avoid delaying or missing treatment.

The effects of red blood cells on coagulation: a thromboelastographic study

BACKGROUND: There are reports suggesting the effect of red blood cells (RBCs) on blood coagulation. The effects of red blood cells (RBCs) on coagulation were investigated in vitro while maintaining other coagulation elements constant. METHODS: Twenty-five healthy male volunteers were enrolled. Citrated fresh whole blood was drawn from each subjects and processed into washed RBCs and platelet-rich plasma (PRP). To make six different hematocrit groups with each blood, PRP was mixed with the same volume of serially diluted washed RBCs. Reaction time, coagulation time, clot formation rate, and maximum amplitude were measured using recalcified TEG. RESULTS: The mean +/- SD of six different hematocrit was 38.0 +/- 2.3% (group 1), 28.9 +/- 2.2% (group 2), 21.3 +/- 1.9% (group 3), 13.8% +/- 1.6% (group 4), 7.1 +/- 1.0% (group 5), and 0 +/- 0% (group 6). The platelet count ranged from 141,000 to 292,000/mm3. Maximum amplitude (r = -0.4213, P< 0.001) and alpha angle (r = -0.216, P< 0.05) showed statistically significant negative linear relationship with hematocrit. CONCLUSIONS: A gradual reduction in hematocrit was associated with a shortened coagulation time, no changes in reaction time. This study results suggest that a gradual reduction in the RBC mass in vitro accelerates coagulation and forms stronger fibrin strands.

Correlation between actual measurement and estimation by hemoglobin dilution method

BACKGROUND: Hemoglobin dilution occurs after acute blood loss, by shifting extravascular blood components into the intravascular space, providing the theoretical possible to calculate amount of blood loss by comparing this difference.Assessing blood loss during the operative procedure is crucial to provide appropriate treatment, however there are few objective standards by which to make this assessment.In this study, we used the hemoglobin dilution method to predict blood loss following an operative procedure. METHODS: During the year 2007, 96 patients who had undergone lumbar spinal fusion surgery were enrolled in this study.On a retrospective basis, we investigated the weight, height, intraoperative blood loss, hemoglobin change, and the amount of transfused erythrocytes by reviewing anesthetic notes from the surgery. On the basis of these data, we calculated estimated blood loss by using Nadler's formula. RESULTS: The majority of study participants were female and average age was 60.1 yrs.We observed 2.3 g/dl decrement of postoperative hemoglobin, and estimated blood volume was 3,599 ml. Estimated blood loss was 853.7 ml, and observed blood loss was 1,070 ml, thus creating 217.1 ml difference.Analysis showed a moderate degree of correlation between observed and estimated values and a correlation coefficient of 0.49. We obtained regression equations of y = 0.828x + 363.5. CONCLUSIONS: Estimated blood loss was underestimated compared to observed values, by 20%, and this discrepancy is was attributed to ethnic differences. To predict a precise estimated blood loss, attempts to make a modified formula targeted to the Korean population are required.

Management of diabetes insipidus during anesthesia for brain germinoma resection in a child : A case report

Diabetes insipidus caused by impaired production or reduced responses to vasopressin, can occasionally be seen postoperatively in neurosurgical patients, but rarely occurs during anesthesia and surgery. An 8-year old female patient with suprasellar germinoma was scheduled for tumor resection. Anesthesia was induced smoothly and maintained mainly with sevoflurane. Several hours after anesthesia and surgery, urine output was increased with increased serum sodium concentration, indicating the occurrence of diabetes insipidus. To prevent sodium increase and replace fluid loss, 2.5% dextrose half saline was used. Though sodium concentration did not increase further, the concomitant increase of glucose complicated anesthetic management. After the completion of anesthesia and surgery, serum sodium increased further but then gradually returned to normal with conservative management. The patient was discharged without any complications.

Discrimination of hemoglobin-effects on arterial-to-jugular bulb oxygen content differences according to arterial carbon dioxide tension

BACKGROUND: Arterial jugular bulb oxygen content differences (AJVDO2) can be related to cerebral blood flow and oxygen consumption. Plasma Hb has been reported to have both-sided effect on AJVDO2. Increased Hb increases oxygen content in artery and jugular bulb, and the net effect is to reduce AJVDO2. Moreover, increasing Hb raises blood viscosity, and could increase AJVDO2. This study was designed to discriminate the Hb-effects on AJVDO2 mathematically. METHODS: Sixty adults were enrolled in this study. General anesthesia and mechanical ventilation were administered. A normocapnic and a subsequent hypocapnic state were achieved. Paired data including 1/AJVDO2, PaCO2, Hb, mean arterial pressure, temperature and anesthetic concentration were recorded during each state. Nonlinear mixed-effects model was applied to fit 1/AJVDO2 using PaCO2 and Hb as covariates. RESULTS: The 1/AJVDO2 was well modeled by PaCO2 and Hb using a three-parameter logistic function: predicted 1/AJv DO2 = 0.38713 / 1+e(31.20981-PaCO2)/25.94210-1.45162xHb The increase in PaCO2 raised the 1/AJVDO2 sigmoidally (P < 0.0001) and its slope was affected by Hb (P = 0.0022). The transition point of the Hb-effect was PaCO2 = 31.20981 (SEM 1.519201). Intraclass correlation coefficient was estimated at 0.9973. CONCLUSIONS: Our finding suggests that the Hb-effect on 1/AJVDO2 is both-sided; the viscosity-effect is dominant at low levels of PaCO2 and effect of oxygen content is dominant at high levels of PaCO2

The Change of Bispectral Index in Endotracheal Intubation with Propofol and Remifentanil without Muscle Relaxant

BACKGROUND: There have been conflicting reports about the effect of muscle relaxant to bispectral index during propofol anesthesia. The purpose of this study was to investigate the change of bispectral index (BIS) in endotracheal intubation with propofol and remifentanil without muscle relaxant and to compare with those in endotracheal intubation with muscle relaxant. METHODS: Forty-eight ASA physical status I or II patients were randomly allocated to 2 groups. Each patient were anesthetized with propofol at target effect site concentration of 4.0microg/ml with remifentanil 3.0microg/kg. Saline was injected in Group S and rocuronium 0.6 mg/kg was injected in Group R. Intubation was attempted, and the BIS, intubating condition, mean arterial pressure and heart rate were observed up to 5 minutes after intubation. RESULTS: BIS was elevated after intubation in Group S. BIS after intubation in group S were significantly higher than group R. BIS after injection of rocuronium in group R was significantly decreased. There were no significant differences in hemodynamic datas in two groups. Intubation condition was acceptable in all patients. CONCLUSIONS: The BIS in endotracheal intubation with propofol and remifentanil without muscle relaxantI can be higher than in endotracheal intubation with muscle relaxant.