A new approach for quantifying the relationship between brain activity patterns and depth of anesthesia (DOA) is presented by analyzing the spatio-temporal patterns in the electroencephalogram (EEG) using Lempel-Ziv complexity analysis. Twenty-seven patients undergoing vascular surgery were studied under general anesthesia with sevoflurane, isoflurane, propofol, or desflurane. The EEG was recorded continuously during the procedure and patients' anesthesia states were assessed according to the responsiveness component of the observer's assessment of alertness/sedation (OAA/S) score. An OAA/S score of zero or one was considered asleep and two or greater was considered awake. Complexity of the EEG was quantitatively estimated by the measure C(n), whose performance in discriminating awake and asleep states was analyzed by statistics for different anesthetic techniques and different patient populations. Compared with other measures, such as approximate entropy, spectral entropy, and median frequency, C(n) not only demonstrates better performance (93% accuracy) across all of the patients, but also is an easier algorithm to implement for real-time use. The study shows that C(n) is a very useful and promising EEG-derived parameter for characterizing the (DOA) under clinical situations.

Although BIS, AAI, and CePROP were influenced by remifentanil during propofol administration, their ability to detect OAA/S and LORlash remained accurate. Improved performance is obtained when BIS and AAI are measured in conjunction with drug targeted effect-site concentrations. Remifentanil decreases the ability of these independent variables to detect LORnoxious.

The qCON was able to reliably detect LOC during general anaesthesia with propofol and remifentanil. The qNOX showed significant overlap between movers and non-movers, but it was able to predict whether or not the patient would move as a response to noxious stimulation, although the anaesthetic concentrations were similar.

For several decades, a number of methods have been developed for the noninvasive assessment of the level of consciousness during general anesthesia. In this paper, detrended fluctuation analysis is used to study the scaling behavior of the electroencephalogram as a measure of the level of consciousness. Three indexes are proposed in order to characterize the patient state. Statistical analysis demonstrates that they allow significant discrimination between the awake, sedated and anesthetized states. Two of them present a good correlation with established indexes of depth of anesthesia. The scaling behavior has been found related to the depth of anesthesia and the methodology allows real-time implementation, which enables its application in monitoring devices.

Bispectral Index, AAI, and predicted propofol effect-site concentration revealed information on the level of sedation and loss of consciousness but did not predict response to noxious stimulus.

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SummaryT he objective of the study was to exam ine the changes in central nervous system (CNS) activity and physical behaviour during induction and awakening from CO 2 anaesthesia. Two studies, each using pigs immersed into 90% CO 2 gas for a period of 60 s were performed. In study 1, we monitored middle latency auditory evoked potentials (changes in latencies, amplitudes and a depth of anaesthesia index), electroencephalographic parameters (delta, theta, alpha and beta electroencephalographic power and 95% spectral edge frequency) and heart rate; and in study 2, we monitored body movements and arterial and venous partial pressure of CO 2 and O 2 . No behavioural signs of distress were observed during the early part of the induction. T he swine exhibited muscular activity from 13±30 s after induction-start as well as during awak ening from anaesthesia, possibly because of a transitory weaker suppression of the brain stem than of the cortex. T he CNS and blood gas param eters started to change from the very start of induction. T he CNS suppression lasted only approxim ately one minute after the end of the induction period. T he two studies indicated a good tem poral relationship between changes in amplitude, depth of anaesthesia index, spectral edge frequency, and arterial P CO 2 during the induction period.

The new monitor was precise. Attenuation of the A-line ARX-index (AAI) for mid-latency auditory evoked potentials (MLAEP) during general anesthesia was profound. However, the monitor did not show a graded response with changing end-expiratory steady-state concentrations of sevoflurane.