(GCS) Glasgow Coma Scale (BIS)

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de5!.#q,! Q ( 6 &6 '#$ 4q<,-! 45 <\ [ q (.* ( 0U! * 0 ) '<5 A[ GCS Q kh BIS i ( '&_C!- ' # "6! &./!--! #$(* l$.#! Z W* ( 'JJN -6@!- * q & 3&_ ( Q& ( "6!** +lc.# l* " 8 S (17) "# i 2/ #@ 67! ; H &6* '#@ 95 $S #@ 80 F&/ &7* 2*!- 16-70 % &.# Q&, 'G 16 &( &F G6S, 'r&5. ( &f J-!! &F!J 'G 70 E &F, l* '6$ -HJU 0 '6$ A[)< &7*) # '#$./!--! (* (:$ #P* C &% ( &! BIS 2 0F # 9 ( &! GCS 2 0F. 0HU & GS 60 :\.# "6 0- :\ ( A[S Qn% &!./!-- ' l$ 3$ i U./!-- &5g ( * B l* & nu 0_! k& A[S ':F &/ A[S '0- ( A[S 'C +[ &7* ( JF &.,HU (./!-- A[S.# "6 BIS GCS 45 ( ' b* v "#*&P ')2P "#*&P ' 5 (! 115 )2P 0F!* T "#! * i 2/ ( 115 )2P 0F T '+Z S!.#Q 0 +!*" HS #*# i&.p!!cc,n ATLS) & \ ( 0C! F&<P &U A7* 0N (Advance traumatic life support 'BIS GCS ( "6 ' "&*.(18) #$ F&/ 0Hc./!--! (* ( &; # ) 0* 0HU & 0N 6$ HJU &7* ( ( GS.#! (* &K &:\ (& A@ #$ F&/ &U #$* BIS &./&cg,. #U 0&! './!--.&/ &U & &F <\ OP &C OP! H- a(7) _ BIS 1990 G 'Ramphil : 'BIS.0 BIS $-! + 2* Johnson!J!! 0 &/-6* & )- b)jd & P & ( 0! F! (Aspect medical system) )2P + A &c 0 "6 &/"( #* & Q.# <* :$D A &c de5! '2K & & & Q 2- ')&Q.f ( '1996 G.(8-11) & #g '2K & A &c P 0 G &&) 0-F &/"( #* +Z i 'BIS Qj 5!% Y) S! &/"( #* ) 'i.(2) kh 2* "6 '!l *.( + &F (* U 2 &7*! 5* B ( 'F&e 2 _ &n& ) ( '_ &/J% 'm &6 W.(12) 0 &!F&@! &Z 2* e U &7* ( '$o a&/ jq * r % #$\ Q 2-*Q &S ( ',@C p * '(E &! #Q 0! &/-6* & )- ( "# ( BIS # &Z.(7 '13) # <* Q! 0JU &## & & &6@ #! # 100 &6@ 2 &3$ '40-60 2, &;* 100 # 0 "# "#l$ C &% G l* & (E eq +F &6 s 'Q p * GeC! % Q (.(14) i '% i!z # &7*! ' #* 0-5 #$(* #$ &F l* 0% &,U &U $ 7$! BIS.#! &./!-- #$* AC "#$$ 0C 2 ( Van Twest '!- : &%!o -He "#$$ MJ ( "6 # & ',@C p *.& "6! &./!-- 0% ' JF ( * 45!Z 25 & & BIS! <* 0%!o -He "#$$ MJ ( "6! (* 0% & T & & #*! &./!-- " <* &; & :.(15) #$ + &F! &./!-- BIS P '% A- JHU A- Y &! # t&e 2!J% (!H$% ( #*.(16) # &cu... &! (!% & &F i ( ) '"(&! (* &7* C A #U l* 0%! "#$$ & P #$\ & '45 0 GCS ( './!-- 2257

& & '! &./!-- ( 64/00 # GCS ;*.(P < 0/021) #Q 0! 57/29 ± 16/96 ± 14/52 & &! &./!-- ( 8/79 ± 2/99 & & SpO 2 '$o.0 "#Q 1 C +[.(P ) 5/29 ± 2/29 G#%! &./!-- ( # ( SpO 2 b6$ # '!- &K #!!*/! a0! 2F 3&! & 0! 2F #C 10 SpO 2 7/4 2! b6$.(1 G#%) (P ) "#< # $ ; H 0F 2F + GCS 'BIS 2F! S! a# BIS $ +Z! '$o.(p = 0/050) (P ) 0 %! &./!-- ;$ #.(1,) 2 G#%) &F kh & 7$! &_C!- l* '! &./!--! #$(* GCS ;* $o BIS ;*! <*!-.#! $ '! &./!-- ( # SpO 2 b6$ # '!- &K ( '$o.0 (.0! 2F 3&! & ( # $ ; H '&; + GCS 'BIS 2F!!*/! a0 % # BIS $ +Z! 2* 0F 2F.# "#<! &./!-- ;$ *& 5 w WH #@ '5 <F 'A &C!% &Z.# 0Hc x&$ # 2 (SpO 2 ) &## & & &6@ 2! # 0-100 BIS # '40-60 &Z, & & 100 C &% G l* & (E 2 &3$.(14) #! &./!-- &7* #$ &F 0% P "; ( 'i 0% &C <\ '[ OP ( ( BIS 2 (E "&* '9 & & GCS '$o.# "6 GCS ( '!-.#! F&/ &7*./!-- & " y6c * #,-!! *( '! &./!-- ( "6 SpO 2 ' GH*!! a 82 ( & Q 2 "#l$ & b-p "; 0_ "##* 3Q U& -HJU 0_! Q k&. #P )$ 20!q* SPSS 2F &*!- ".#&/,JN!2l (version 20, SPSS Inc., Chicago, IL) (Q, '" 2-*Q 0% "6 Q (Q.#* Regression 2-*Q Pearson ; H 'Independent t.#! F&/ &7* $ $! P < 0/050 6@ * 0 2&! % & ( &6* ( &6* 6 & (#@ 75) &6* 18 # '#*#!-! 41/86 ± 17/54 & & &F ;* #* ( (#@ 25) & & # BIS ;*! # 4q< '$o. G! "#.1 P 0/021 0/847 0/174 0/010 0/880 0/410 0/495 "#! ± 57/29 ± 14/52 5/29 ± 2/29 101/33 ± 21/19 95/95 ± 6/39 70/33 ± /54 36/63 ± 1/80 99/28 ± 25/07 62/36 ± 12/63 11/2 ± 1/20 93/12 ± 6/56! BIS: Bispectral index; GCS: Glasgow coma scale; SQI: Signal quality index " #! ± 64/00 ± 16/96 8/79 ± 2/99 100/87 ± 18/43 97/25 ± 4/96 81/16 ± 17/00 36/62 ± 1/78 103/08 ± 28/3 64/27 ± 16/16 18/60 ± 6/00 83/12 ± 8/04! BIS GCS +, #-. SQI /-0123-4 # 7-8 65 1 92 1: / 1 ; 1: / <=> ;- 1: @29A BC 2258

! "# (GCS) Glasgow coma scale (BIS) Bispectral index GCS 0/372 0/073 0/338 0/106 * 0/440 0/031 * 0/468 0/021 0/170 0/428 0/440 0/031 BIS: Bispectral index; GCS: Glasgow coma scale BIS ** 0/656 0/170 0/428 0/338 0/106 ** 0/656 * 0/468 0/021 0/372 0/073 $%&' Pearson ()# %&'.2 33 3# BIS -> 6G0414 D=! BIS 33 3# GCS -> 6G0414 D=! GCS P<0/010 :** ap<0/050 :* l* b) &( '! &./!--! &f OP 0-F!*<*! BIS SH 0 ) ) Slavov!-.(23) #! #* '0 b) ' Z- ( bp G 5 <F A &K! # "#<! &./!-- P);$E! OP BIS ( &YC GF "; &S ( N M* A)&N.() # 3H 0 ) #$ 2K! '2K!U :H< "#$$ &c 0 ) ' & $ a(22) #* &/-6* & )- & GF! Qj 5 OP 0% #- +Z C #- &/J 100 2l.(23) # F*! &./!-- &/J 2 " &! @ ' Z- (,HU # BIS ~ ' "6 q Q $! E( #.# 0J! &_C!- BIS 0 )! (25) #-! # "#< Durieux Gaughen!- BIS 0 U ' 2l JF " &! @ +Z &f A@! #- '# &7*!.(26) # &S (./ &c BIS A &K #* '#$$ &c / "#*&/! A &c 0Z &c &; A- 'F&S (.(25) # <* 5 &)J.(27) 0 "# "# / "#*&/ #-!6U ( * 2K b) :&N # &7*! '"[! #P.# _ "#$$ bc T & # A@! )&N je # "(% & %(2 (GCS) Glasgow coma scale /01 #.1,-. " (BIS) Bispectral index <F 2F 3H 3Jf '! &./!-- P);$E ' :$ A &K! 3JU &_ 5 ( &/J% &.(19) #! " &! &5 #* bc 2l!J% ( 6J q i '0_ T HJU & &J '_ "#$$.(20) &/ &U "6 eeq,u A@! BIS! #*& "#< ' ) Guignard P);$E GH*! GFP&P # 2 C % ) Mi!-.(21) # 2F! &./!--! 0 -C a(22) #Q 0! <!l * 2*.# "#< BIS 2 $ '&_C!- 2259

(!H$% ( #* BIS P! #! 6/ &P! ( ' t&e 2!J%! #* <* ) Gan '$o.(17) # &cu... &,FP&P t&e 2 #* BIS 45 ( "6.(31) # &cu S &_C!- :$ A &K!!!% ' & GCS! 0H* BIS A &K $o + & < kh :$ A &K & < BIS! 0F.# <*! &./!--! B $!( )* "! )2P!F&C &!*P (! F&/&!-Z 0* "(C $ 0C 0 291003 &S #.0! F l* 6@ )2P J ";<* <wp & N.#Q,! &)< &#Z 22 AC( (!J '!l * )&N 0-F 2F! &l$! #$*, 3U ( '&; t&s (.(28) &/ p$< (& &.(29) #* 2* p$< l 'l$< #_ 0@5 & "[ 0 + &_C!- :$ A &K 'Y ' (.# & GCS! 0H* BIS A &K '$o kh :$ A &K & < BIS! 0F.# <*! &./!--! B & < $ 7$! BIS 2 (!- S 'van Twest &%!o -He "#$$ MJ ( "6 # & <* p *.& "6! &./!-- 0% & ' JF ( *! #$ 45!Z 25 & & BIS! + &F! &./!-- 0% & T &! &./!-- 0%!o -He "#$$ MJ ( "6!< ) Kimura!-.(15) #* (* p * 'A6 #* % 2*! &./!-- 0%.(30) 0 < References 1. Sebel PS, Lang E, Rampil IJ, White PF, Cork R, Jopling M, et al. A multicenter study of bispectral electroencephalogram analysis for monitoring anesthetic effect. Anesth Analg 1997; 84(4): 891-9. 2. March PA, Muir WW. Bispectral analysis of the electroencephalogram: a review of its development and use in anesthesia. Vet Anaesth Analg 2005; 32(5): 1-55. 3. Motoyama E, Gronert BJ, Fine GF. Induction of anesthesia and maintenance of the airway in infants and children. In: Motoyama E, Davis P, editors. Smith's anesthesia for infants and children. Philadelphia, PA: Mosby; 2005. p. 3-41. 4. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Glasgow coma scale score. J Neurotrauma 2000; 17(6-7): 563-71. 5. Bahloul M, Chelly H, Ben HM, Ben HC, Ksibi H, Kallel H, et al. Prognosis of traumatic head injury in South Tunisia: a multivariate analysis of 437 cases. J Trauma 2004; 57(2): 255-61. 6. Signorini DF, Andrews PJ, Jones PA, Wardlaw JM, Miller JD. Predicting survival using simple clinical variables: a case study in traumatic brain injury. J Neurol Neurosurg Psychiatry 1999; 66(1): 20-5. 7. Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology 1998; 89(4): 980-1002. 8. Hayashida M, Sekiyama H, Orii R, Chinzei M, Ogawa M, Arita H, et al. Effects of deep hypothermic circulatory arrest with retrograde cerebral perfusion on electroencephalographic bispectral index and suppression ratio. J Cardiothorac Vasc Anesth 2007; 21(1): 61-7. 9. Oda Y, Nishikawa K, Hase I, Asada A. The shortacting beta1-adrenoceptor antagonists esmolol and landiolol suppress the bispectral index response to tracheal intubation during sevoflurane anesthesia. Anesth Analg 2005; 100(3): 733-7, table. 10. Hans P, Dewandre PY, Brichant JF, Bonhomme V. Comparative effects of ketamine on Bispectral Index and spectral entropy of the electroencephalogram under sevoflurane anaesthesia. Br J Anaesth 2005; 94(3): 336-40. 11. Kushida A, Murao K, Kimoto M, Nakao S, Shingu K. Fentanyl shows different effects by administration routes on bispectral index during spinal anesthesia in patients undergoing cesarean section. Masui 2006; 55(11): 1393-7. [In Japanese]. 12. Davidson A. The correlation between bispectral index and airway reflexes with sevoflurane and halothane anaesthesia. Pediatric Anesthesia 2004; 14(3): 1-6. 13. Sigl JC, Chamoun NG. An introduction to bispectral analysis for the electroencephalogram. J Clin Monit 1994; 10(6): 392-404. 14. Stanski DR, Shafer SL. Measuring depth of anesthesia. In: Miller RD, editor. Miller's anesthesia. 6 th ed. London, UK: Churchill Livingstone; 2004. p. 1250-6. 15. van Twest RM. Bispectral index guided timing of intubation without neuromuscular blockade during sevoflurane induction of anaesthesia in adults. Anaesth Intensive Care 2006; 34(5): 606-12. 16. Klopman MA, Sebel PS. Cost-effectiveness of bispectral index monitoring. Curr Opin Anaesthesiol 2011; (2): 177-81. 17. Paul DB, Umamaheswara Rao GS. Correlation of 2260

Bispectral Index with Glasgow Coma Score in mild and moderate head injuries. J Clin Monit Comput 2006; 20(6): 399-404. 18. American College of Surgeons. ATLS: Advanced trauma life support for doctors. 6 th ed. Chicago, IL: American College of Surgeons; 2010. 19. Forbes AM, Dally FG. Acute hypertension during induction of anaesthesia and endotracheal intubation in normotensive man. Br J Anaesth 1970; 42(7): 618-. 20. Mireskandari SM, Abulahrar N, Darabi ME, Rahimi I, Haji-Mohamadi F, Movafegh A. Comparison of the effect of fentanyl, sufentanil, alfentanil and remifentanil on cardiovascular response to tracheal intubation in children. Iran J Pediatr 2011; 21(2): 173-80. 21. Guignard B, Menigaux C, Dupont X, Fletcher D, Chauvin M. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg 2000; 90(1): 161-7. 22. Mi WD, Sakai T, Takahashi S, Matsuki A. Haemodynamic and electroencephalograph responses to intubation during induction with propofol or propofol/fentanyl. Can J Anaesth 1998; 45(1): 19-22. 23. Kim WY, Lee YS, Ok SJ, Chang MS, Kim JH, Park YC, et al. Lidocaine does not prevent bispectral index increases in response to endotracheal intubation. Anesth Analg 2006; 102(1): 156-9.. Slavov V, Motamed C, Massou N, Rebufat Y, Duvaldestin P. Systolic blood pressure, not BIS, is associated with movement during laryngoscopy and intubation. Can J Anaesth 2002; 49(9): 918-21. 25. Groves DS, Malik ZM, Durieux ME. Midazolam modulates effects of intravenous lidocaine on bispectral index (BIS). Anesthesiology 2007; 107: A803. 26. Gaughen CM, Durieux M. The effect of too much intravenous lidocaine on bispectral index. Anesth Analg 2006; 103(6): 1464-5. 27. Nordmark J, Rydqvist B. Local anaesthetics potentiate GABA-mediated Cl- currents by inhibiting GABA uptake. Neuroreport 1997; 8(2): 465-8. 28. Charles B. Berde and Gary R. Local Anesthetics: Miller RD 7 th ed. Miller's anesthesia. London, UK: Churchill Livingstone; 2010. p: 932. 29. Modica PA, Tempelhoff R, White PF. Pro- and anticonvulsant effects of anesthetics (Part I). Anesth Analg 1990; 70(3): 303-15. 30. Kimura T, Watanabe S, Asakura N, Inomata S, Okada M, Taguchi M. Determination of end-tidal sevoflurane concentration for tracheal intubation and minimum alveolar anesthetic concentration in adults. Anesth Analg 1994; 79(2): 378-81. 31. Gan TJ, Glass PS, Windsor A, Payne F, Rosow C, Sebel P, et al. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology 1997; 87(4): 808-15. 2261

Journal of Isfahan Medical School Received: 27.09.2015 Vol. 33, No. 364, 4 th Week, February 2016 Accepted: 30.01.2016 The Relationship between the Scores of Bispectral Index (BIS) and Glasgow Coma Scale (GCS) in Poisoned Patients with Decreased Level of Consciousness Requiring Tracheal Intubation Mitra Jabal-Ameli MD 1, Nastaran Eizadi-Mood MD 2, Parisa Tavangar-Rad 3, Ahmad Yaraghi MD 1 Abstract Original Article Background: Determining the depth of anesthesia or loss of consciousness in poisoned patients admitted to hospitals is one of the most important issues in determining the necessity to tracheal intubation. This study aimed to investigate the relationship between the scores of Bispectral index (BIS) and Glasgow coma scale (GCS) in poisoned patients with loss of consciousness requiring tracheal intubation. Methods: poisoned patients referred to Noor Hospital in Isfahan, Iran were enrolled. The level of consciousness was recorded using the GCS and BIS in two times, one at the beginning and the other at the time of tracheal intubation. Finally, the data were analyzed using independent-t and Pearson's correlation and regression analysis tests via SPSS software. Findings: There was a significant correlation between the BIS and GCS scores at admission that as BIS increased in patients, the GCS score increased, too (P = 0.050). In addition, a significant relationship was found between the BIS scores at the admission and during tracheal intubation (P = 0.001). Conclusion: As in our study, the hemodynamic changes was very low and the BIS changes was lower than the GCS, we can understand that BIS is more indicative in showing hemodynamic changes and complications associated with tracheal intubation. Keywords: Bispectral index (BIS), Glasgow coma scale (GCS) Intubation, Poisoned Citation: Jabal-Ameli M, Eizadi-Mood N, Tavangar-Rad P, Yaraghi A. The Relationship between the Scores of Bispectral Index (BIS) and Glasgow Coma Scale (GCS) in Poisoned Patients with Decreased Level of Consciousness Requiring Tracheal Intubation. J Isfahan Med Sch 2016; 33(364): 2256-62 1- Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 2-Professor, Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 3- Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran Corresponding Author: Parisa Tavangar-Rad, Email: parisa.t.rad@gmail.com 2262