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British Journal of Anaesthesia, 2002, Vol. 89, No. 4 551-555
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Comparison of ocular microtremor and bispectral index during sevoflurane anaesthesia{dagger}

L. G. Kevin*,1, A. J. Cunningham1 and C. Bolger2

1 Department of Anaesthesia, Beaumont Hospital, Dublin 9, Ireland. 2 Department of Neurosurgery, Beaumont Hospital, Dublin 9, Ireland*Corresponding author: Leo G. Kevin, Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA

{dagger}No financial support was received for this work.

Background. A practical and reliable monitor of depth of anaesthesia would be a major advance on current clinical practice. None of the present monitors is both simple to use and accurate. Ocular microtremor (OMT) is a physiological tremor that is suppressed by propofol in a dose-dependent manner. We studied OMT during propofol induction and nitrous oxide– oxygen–sevoflurane maintenance of anaesthesia in 30 patients, and compared OMT with the bispectral index (BIS) as a predictor of response to verbal command.

Methods. OMT was measured using the closed-eye piezoelectric strain-gauge technique. OMT and BIS were measured at specific times during the anaesthetic, including at loss of consciousness, at end-tidal sevoflurane 1 and 2%, and at emergence.

Results. OMT decreased significantly after induction, did not decrease as end-tidal sevoflurane was increased from 1 to 2%, and increased at emergence in all patients. By logistic regression, OMT was more sensitive and specific than BIS in distinguishing the awake from the anaesthetized state (OMT, 84.9 and 93.1% respectively; BIS, 75.7 and 69.0%).

Conclusions. OMT is suppressed by sevoflurane and accurately predicts response to verbal command. OMT may be a useful monitor of depth of hypnosis.

Br J Anaesth 2002; 89; 551–5


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