ASSESSING ANESTHETIC DEPTH

Response Pupillary
Stage of Cardiovascular Eyeball Pupil Muscle Reflex
Behavior Respiration to Depth Light
Anesthesia Function Position Size Tone Response
Surgery Response

Normal, may
be panting HR unchanged Not
Stage I Disoriented Struggle Central Normal Yes Good All present
RR 20-30 Hypertension anesthetized
bpm

Stage II Excitement Irregular, may HR may Central, All present,

Not May be
excitatory struggling hold breath or increase Struggle possible Yes Good may be
anesthetized dilated
stage vocalization hyperventilate Hypertension nystagmus exaggerated

Swallowing
Stage III, May Central or poor or
Regular Pulse strong
Plane 1 respond rotated, absent,
Anesthetized RR 12-20 HR >90 bpm Light Normal Yes Good
light with may be others
bpm Normal BP
anesthesia movement nystagmus present but
diminished
Patellar, ear
flick,
palpebral
Stage III, Regular, may
HR > 90 bpm HR and Often and corneal
Plane 2 be shallow Slightly Relaxed
Anesthetized Increasing RR may Moderate rotated Sluggish may be
surgical RR 12-16 dilated
hypotension increase ventrally present (but
anesthesia bpm
diminished),
others
absent
HR 60-90 bpm
Stage III, CRT increased, Usually
All reflexes
Plane 3 Shallow pulse less central, Moderately Very sluggish Greatly
Anesthetized None Deep diminished
deep RR <12 bpm strong may rotate dilated or absent reduced
or absent
anesthesia Increasing ventrally
hypotension
HR < 60 bpm
Stage III, Prolonged CRT,
Widely No reflex
Plane 4 Anesthetized Jerky pale mm None Overdose Central Unresponsive Flaccid
dilated activity
Significant
Hypotension

Cardiovascular Widely No reflex

Stage IV Moribund Apnea None Dying Central Unresponsive Flaccid
collapse dilated activity