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The Narcotrend index indicates age-related changes during propofol induction in children.
Anesth Analg. 2009 Jul; 109(1):53-9.A&A

Abstract

BACKGROUND

The Narcotrend electroencephalogram monitor is designed to measure hypnotic state during anesthesia. We performed this study to evaluate the effectiveness and reliability of the Narcotrend monitor in assessing hypnotic state and loss of consciousness (LOC) during propofol anesthesia induction in children.

METHODS

Sixty-two children, aged 1-5 (n = 17), 6-12 (n = 23), and 13-16 (n = 21) yr, scheduled for elective surgery were studied. The patients were premedicated with oral midazolam 0.5 mg/kg. After IV access, propofol target controlled infusion (TCI) was started with 0.5 microg/mL and increased by 0.5 microg/mL increments every 2 min until the child did not respond to any verbal command or physical stimuli. A manual scheme was used for children weighing <15 kg. Hypnotic state was measured every minute from the start of the propofol infusion using the University of Michigan Sedation Scale (UMSS). LOC was defined as a transition of UMSS scale value 2 to 3. The Narcotrend index (NI) was recorded before the start of induction and during the whole study period. NI values were noted simultaneously, yet independently of the sedation measurements. Prediction probability (PK) was used to assess the correspondence between NI and UMSS. Sensitivity and specificity of NI for differentiating between consciousness and unconsciousness were calculated. NI values at specific UMSS levels were compared between the different age groups and the relationships between TCI propofol concentrations and sedation levels were assessed using correlation analysis.

RESULTS

A PK-value of 0.84 (95% CI [0.80-0.88]) of NI was calculated from the data for the detection of LOC. Similarly, a PK value of 0.82 (95% CI [0.78-0.86]) indicated agreement between NI and UMSS values. The average NI values differed between successive UMSS sedation levels 0 and 1 and levels 1 and 2 (P < 0.01). In the youngest age group, the NI discriminated between UMSS levels 2 and 3, in the second age group between levels 1 and 2 and 2 and 3, and in the oldest age group between 0 and 1. Furthermore, the NI values differed significantly between age groups at UMSS levels 1-4 (P < 0.005), with the NI values being higher in younger compared with older children. The average NI value at LOC was 68. For the detection of consciousness, a sensitivity of 0.67 and specificity of 0.79 were achieved. Spearman correlation coefficients indicated higher association between TCI propofol concentrations and UMSS (0.96) than between NI and UMSS (-0.68).

CONCLUSIONS

During propofol induction in children, the Narcotrend electroencephalogram monitor was capable of following changes in the sedation level of children to some extent, but also had a relatively high probability (0.18) of incorrectly predicting changes in conscious state. Therefore, the monitor should not solely be used to guide sedation and anesthesia. NI was age-dependent and younger children had higher NI-values than older children at the same level of sedation.

Authors+Show Affiliations

Department of Anesthesiology and Intensive Care Medicine, Children's Hospital, Helsinki University Clinics, PL 281, 00029 HUS, Finland. sinikka.munte@hus.fiNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19535695

Citation

Münte, Sinikka, et al. "The Narcotrend Index Indicates Age-related Changes During Propofol Induction in Children." Anesthesia and Analgesia, vol. 109, no. 1, 2009, pp. 53-9.
Münte S, Klockars J, van Gils M, et al. The Narcotrend index indicates age-related changes during propofol induction in children. Anesth Analg. 2009;109(1):53-9.
Münte, S., Klockars, J., van Gils, M., Hiller, A., Winterhalter, M., Quandt, C., Gross, M., & Taivainen, T. (2009). The Narcotrend index indicates age-related changes during propofol induction in children. Anesthesia and Analgesia, 109(1), 53-9. https://doi.org/10.1213/ane.0b013e3181a49c98
Münte S, et al. The Narcotrend Index Indicates Age-related Changes During Propofol Induction in Children. Anesth Analg. 2009;109(1):53-9. PubMed PMID: 19535695.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Narcotrend index indicates age-related changes during propofol induction in children. AU - Münte,Sinikka, AU - Klockars,Jaakko, AU - van Gils,Mark, AU - Hiller,Arja, AU - Winterhalter,Michael, AU - Quandt,Christina, AU - Gross,Matthias, AU - Taivainen,Tomi, PY - 2009/6/19/entrez PY - 2009/6/19/pubmed PY - 2009/7/22/medline SP - 53 EP - 9 JF - Anesthesia and analgesia JO - Anesth Analg VL - 109 IS - 1 N2 - BACKGROUND: The Narcotrend electroencephalogram monitor is designed to measure hypnotic state during anesthesia. We performed this study to evaluate the effectiveness and reliability of the Narcotrend monitor in assessing hypnotic state and loss of consciousness (LOC) during propofol anesthesia induction in children. METHODS: Sixty-two children, aged 1-5 (n = 17), 6-12 (n = 23), and 13-16 (n = 21) yr, scheduled for elective surgery were studied. The patients were premedicated with oral midazolam 0.5 mg/kg. After IV access, propofol target controlled infusion (TCI) was started with 0.5 microg/mL and increased by 0.5 microg/mL increments every 2 min until the child did not respond to any verbal command or physical stimuli. A manual scheme was used for children weighing <15 kg. Hypnotic state was measured every minute from the start of the propofol infusion using the University of Michigan Sedation Scale (UMSS). LOC was defined as a transition of UMSS scale value 2 to 3. The Narcotrend index (NI) was recorded before the start of induction and during the whole study period. NI values were noted simultaneously, yet independently of the sedation measurements. Prediction probability (PK) was used to assess the correspondence between NI and UMSS. Sensitivity and specificity of NI for differentiating between consciousness and unconsciousness were calculated. NI values at specific UMSS levels were compared between the different age groups and the relationships between TCI propofol concentrations and sedation levels were assessed using correlation analysis. RESULTS: A PK-value of 0.84 (95% CI [0.80-0.88]) of NI was calculated from the data for the detection of LOC. Similarly, a PK value of 0.82 (95% CI [0.78-0.86]) indicated agreement between NI and UMSS values. The average NI values differed between successive UMSS sedation levels 0 and 1 and levels 1 and 2 (P < 0.01). In the youngest age group, the NI discriminated between UMSS levels 2 and 3, in the second age group between levels 1 and 2 and 2 and 3, and in the oldest age group between 0 and 1. Furthermore, the NI values differed significantly between age groups at UMSS levels 1-4 (P < 0.005), with the NI values being higher in younger compared with older children. The average NI value at LOC was 68. For the detection of consciousness, a sensitivity of 0.67 and specificity of 0.79 were achieved. Spearman correlation coefficients indicated higher association between TCI propofol concentrations and UMSS (0.96) than between NI and UMSS (-0.68). CONCLUSIONS: During propofol induction in children, the Narcotrend electroencephalogram monitor was capable of following changes in the sedation level of children to some extent, but also had a relatively high probability (0.18) of incorrectly predicting changes in conscious state. Therefore, the monitor should not solely be used to guide sedation and anesthesia. NI was age-dependent and younger children had higher NI-values than older children at the same level of sedation. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/19535695/The_Narcotrend_index_indicates_age_related_changes_during_propofol_induction_in_children_ L2 - https://doi.org/10.1213/ane.0b013e3181a49c98 DB - PRIME DP - Unbound Medicine ER -