Correlation between the Observer's Assessment of Alertness/Sedation score and bispectral index in patients receiving propofol titration during general anesthesia induction

doi:10.12122/j.issn.1673-4254.2025.01.07

Abstract

Abstract:

Objective To explore the relationship between the Observer's Assessment of Alertness/Sedation (OAAS) score and the bispectral index (BIS) during propofol titration for general anesthesia induction and analyze the impact of BIS monitoring delay on anesthetic depth assessment. Methods This study was conducted among 90 patients (ASA class I-II) undergoing elective surgery under general anesthesia. For anesthesia induction, the patients received propofol titration at the rate of 0.5 mg·kg^-1·min^-1 till OAAS scores of 4, 3, 2, and 1 were reached. After achieving an OAAS score of 1, remifentanil (2 μg·kg⁻¹) and rocuronium (0.6 mg·kg⁻¹) were administered, and tracheal intubation was performed 2 min later. BIS values, mean arterial pressure (MAP), heart rate (HR), and propofol dosage at each OAAS score were recorded, and the correlation between OAAS scores and BIS values was analyzed. The diagnostic performance of BIS values for determining when the OAAS score reaches 1 was analyzed using ROC curve. Results All the patients successfully completed tracheal intubation. BIS values of the patients at each of the OAAS scores differed significantly (P<0.01), and the mean BIS value decreased by 4.08, 8.32, 5.43 and 5.24 as the OAAS score decreased from 5 to 4, from 4 to 3, from 3 to 2, and from 2 to 1, respectively. There was a significant correlation between the OAAS score and BIS values (ρ=0.775, P<0.001). The median BIS value for an OAAS score of 1 was 76, at which point 83.33% of the patients had BIS values exceeding 60. ROC curve analysis showed that for determining an OAAS score of 1, BIS value, at the optimal cutoff value of 84, had a sensitivity of 88.9%, a specificity of 73.3%, and an area under the curve of 0.842 (0.803-0.881). Conclusion OAAS score during induction of general anesthesia is strongly correlated with BIS value and is a highly sensitive and timely indicator to compensate for the delay in BIS monitoring.

Key words: general anesthesia induction, propofol, Observer's Assessment of Alertness/Sedation score, bispectral index, monitoring delay

Lihong CHEN, Huilin XIE, Xia HUANG, Tongfeng LUO, Jing GUO, Chunmeng LIN, Xueyan LIU, Lishuo SHI, Sanqing JIN. Correlation between the Observer's Assessment of Alertness/Sedation score and bispectral index in patients receiving propofol titration during general anesthesia induction[J]. Journal of Southern Medical University, 2025, 45(1): 52-58.

Figures/Tables 6

References 45

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Characteristics	Result
Age (year)	43.52±11.25
Gender
Male	47 (52.2%)
Female	43(47.8%)
Body weight (kg)	62.48±10.47
Height (m)	1.65±0.08
BMI (kg·m^-2)	22.80±2.75
Hb (g·L^-1)	130.33±17.85
Alb (g·L^-1)	41.18±3.17
Dose of remifentanil (μg)	132.36±22.16
Dose of rocuronium (mg)	37.49±6.28
ASA Grade
1	5 (5.56%)
2	85 (94.44%)
NYHA grading
Ⅰ	30 (33.33%)
Ⅱ	60 (66.67%)

Characteristics	Result
Age (year)	43.52±11.25
Gender
Male	47 (52.2%)
Female	43(47.8%)
Body weight (kg)	62.48±10.47
Height (m)	1.65±0.08
BMI (kg·m^-2)	22.80±2.75
Hb (g·L^-1)	130.33±17.85
Alb (g·L^-1)	41.18±3.17
Dose of remifentanil (μg)	132.36±22.16
Dose of rocuronium (mg)	37.49±6.28
ASA Grade
1	5 (5.56%)
2	85 (94.44%)
NYHA grading
Ⅰ	30 (33.33%)
Ⅱ	60 (66.67%)

OAAS score	BIS value	Titration time (s)	Dose of propofol (mg/kg)	MAP (mmHg)	HR (bpm)
5	96[94, 97]	-	-	99.14±11.23	80.37±13.32
4	93[87, 97]	120±34	1.00±0.27	91.66±10.92	79.74±11.34
3	82[80, 88]	163±39	1.35±0.32	87.01±10.87	78.77±10.44
2	79[74, 82]	188±45	1.56±0.37	83.60±10.85	78.64±10.52
1	76[66, 81]	206±49	1.70±0.41	82.39±11.25	77.78±10.63

OAAS score	BIS value	Titration time (s)	Dose of propofol (mg/kg)	MAP (mmHg)	HR (bpm)
5	96[94, 97]	-	-	99.14±11.23	80.37±13.32
4	93[87, 97]	120±34	1.00±0.27	91.66±10.92	79.74±11.34
3	82[80, 88]	163±39	1.35±0.32	87.01±10.87	78.77±10.44
2	79[74, 82]	188±45	1.56±0.37	83.60±10.85	78.64±10.52
1	76[66, 81]	206±49	1.70±0.41	82.39±11.25	77.78±10.63

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