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Variability comparison of the composite auditory evoked potential index and the bispectral index during propofol-fentanyl anesthesia.
Anesth Analg. 2008 Jul; 107(1):117-24.A&A

Abstract

BACKGROUND

Monitors of hypnotic depth help anesthesiologists to guide the anesthetic. The performance of different monitors depends on several factors, index variability at a steady state of hypnotic depth being one. We compared the recently introduced AAI1.6 with the established bispectral index (BIS), regarding index variability during stable values of propofol effect-site concentration.

METHODS

After ethics committee approval and written informed consent, anesthesia was performed in 40 patients with propofol as the target controlled infusion and fentanyl. Variability of BIS and AAI1.6 was calculated during periods of constant predicted propofol effect compartment concentration and constant levels of surgical stimulation as the median absolute deviation (MAD) from the median value. A variability index was calculated as 1.48*MAD/(threshold - median value), with threshold being the division line between awake and asleep. Threshold crossing time was used to evaluate the performance in predicting return of consciousness.

RESULTS

Variability index, however, was significantly larger for the AAI1.6, despite similar absolute variability measured as MAD. Lightening of anesthesia before recovery could be noticed earlier using the BIS than the AAI1.6, although consciousness was detected with a significantly higher Pk-value by the AAI1.6.

CONCLUSION

Variability in relation to the difference between the median index value during anesthesia and the threshold necessary to detect consciousness with high sensitivity is higher for the AAI1.6 than for the BIS. This, as well as the steeper concentration-response function found for AAI1.6, impairs the performance of the AAI1.6 in predicting imminent return of consciousness during decreasing propofol concentrations. However, it makes AAI1.6 well suited to detect consciousness when it has occurred.

Authors+Show Affiliations

Department of Anesthesiology, Charité- Universitaetsmedizin Berlin, Berlin, Germany. benno. rehberg@charite.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18635476

Citation

Rehberg, Benno, et al. "Variability Comparison of the Composite Auditory Evoked Potential Index and the Bispectral Index During Propofol-fentanyl Anesthesia." Anesthesia and Analgesia, vol. 107, no. 1, 2008, pp. 117-24.
Rehberg B, Ryll C, Hadzidiakos D, et al. Variability comparison of the composite auditory evoked potential index and the bispectral index during propofol-fentanyl anesthesia. Anesth Analg. 2008;107(1):117-24.
Rehberg, B., Ryll, C., Hadzidiakos, D., Dincklage, F. V., & Baars, J. H. (2008). Variability comparison of the composite auditory evoked potential index and the bispectral index during propofol-fentanyl anesthesia. Anesthesia and Analgesia, 107(1), 117-24. https://doi.org/10.1213/ane.0b013e31816f1965
Rehberg B, et al. Variability Comparison of the Composite Auditory Evoked Potential Index and the Bispectral Index During Propofol-fentanyl Anesthesia. Anesth Analg. 2008;107(1):117-24. PubMed PMID: 18635476.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Variability comparison of the composite auditory evoked potential index and the bispectral index during propofol-fentanyl anesthesia. AU - Rehberg,Benno, AU - Ryll,Christiane, AU - Hadzidiakos,Daniel, AU - Dincklage,Falk V, AU - Baars,Jan H, PY - 2008/7/19/pubmed PY - 2008/8/22/medline PY - 2008/7/19/entrez SP - 117 EP - 24 JF - Anesthesia and analgesia JO - Anesth Analg VL - 107 IS - 1 N2 - BACKGROUND: Monitors of hypnotic depth help anesthesiologists to guide the anesthetic. The performance of different monitors depends on several factors, index variability at a steady state of hypnotic depth being one. We compared the recently introduced AAI1.6 with the established bispectral index (BIS), regarding index variability during stable values of propofol effect-site concentration. METHODS: After ethics committee approval and written informed consent, anesthesia was performed in 40 patients with propofol as the target controlled infusion and fentanyl. Variability of BIS and AAI1.6 was calculated during periods of constant predicted propofol effect compartment concentration and constant levels of surgical stimulation as the median absolute deviation (MAD) from the median value. A variability index was calculated as 1.48*MAD/(threshold - median value), with threshold being the division line between awake and asleep. Threshold crossing time was used to evaluate the performance in predicting return of consciousness. RESULTS: Variability index, however, was significantly larger for the AAI1.6, despite similar absolute variability measured as MAD. Lightening of anesthesia before recovery could be noticed earlier using the BIS than the AAI1.6, although consciousness was detected with a significantly higher Pk-value by the AAI1.6. CONCLUSION: Variability in relation to the difference between the median index value during anesthesia and the threshold necessary to detect consciousness with high sensitivity is higher for the AAI1.6 than for the BIS. This, as well as the steeper concentration-response function found for AAI1.6, impairs the performance of the AAI1.6 in predicting imminent return of consciousness during decreasing propofol concentrations. However, it makes AAI1.6 well suited to detect consciousness when it has occurred. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/18635476/Variability_comparison_of_the_composite_auditory_evoked_potential_index_and_the_bispectral_index_during_propofol_fentanyl_anesthesia_ L2 - https://doi.org/10.1213/ane.0b013e31816f1965 DB - PRIME DP - Unbound Medicine ER -