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Anesth Analg 2005;101:382-384
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000150943.87520.6D

ANESTHETIC PHARMACOLOGY

Does Yawning Represent a Transient Arousal-Shift During Intravenous Induction of General Anesthesia?

Yoshiko Kasuya, MD*, Tatsuo Murakami, MD*, Tsutomu Oshima, MD{dagger}, and Shuji Dohi, MD{dagger}

*Division of Anesthesia, Gifu Red Cross Hospital; and {dagger}Department of Anesthesiology, Gifu University Graduate School of Medicine, Gifu-City, Japan

Address correspondence and reprint requests to Tsutomu Oshima, MD, Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu 501-1194, Japan. Address e-mail to oshimat{at}cc.gifu-u.ac.jp.

Although yawning occurs frequently during the IV induction of general anesthesia, the significance of this response remains unknown. In this study, we induced 30 surgical patients with 4 mg/kg thiopental IV, and 30 patients with 2 mg/kg propofol IV. Thereafter, the occurrence of yawning was continuously assessed, as the only clinical end-point, for 1 min. The electroencephalographic bispectral index was monitored throughout the observation period. The criterion for an arousal response was a transient increase during a continuing decrease in the bispectral index value. On the basis of this criterion, the sensitivity and specificity of the yawning response as an arousal sign were 77% and 80%, respectively. If a patient exhibited a yawning response, the chance of arousal was 84% (positive predictive value). With no yawning response, the chance of nonarousal was 71% (negative predictive value). According to simple logistic regression, the yawning response was predictive of a transient arousal-shift with an odds ratio of 13.5 (95% confidence interval: 3.8–48; P < 0.001). The occurrence of a yawning response during IV induction may be a clinical indicator of a transient arousal-shift during progressive loss of consciousness.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.