Application of Bispectral Index® and Narcotrend® Index to the Measurement of the Electroencephalographic Effects of Isoflurane with and without Burst Suppression

Kreuer, Sascha; Bruhn, Jørgen; Larsen, Reinhard; Grundmann, U.; Shafer, Steven L.; Wilhelm, Wolfram

doi:10.1097/00000542-200410000-00008

Cited by 56 publications

(38 citation statements)

References 15 publications

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“…At the first attempt, the minimization of NONMEM was not successful for either the BIS data or CSI data using the classical sigmoidal E max model, which could not adequately quantify the doseresponse relationship (data not shown). Some studies have explained the EEG data showing a pharmacodynamic plateau with E max models that are divided into two periods, before and after the onset of burst suppression [9,10] . The pharmacodynamic plateau appeared when the BIS value was approximately 40 during sevoflurane anesthesia [10] .…”

Section: Discussionmentioning

confidence: 99%

“…The mean individual predictive E 02 value of 38.7 for the BIS, close to 40 as shown in other studies, suggests that the transition point into burst suppression can be properly described with our model. The pharmacodynamic plateau in the BIS may be more prominent with anesthetics when the duration of one sequence for increasing or decreasing concentrations of the anesthetic agent is short, which is more clinically applicable [9][10][11] .…”

Section: Discussionmentioning

confidence: 99%

“…A classical sigmoidal E max model has been commonly used to describe the dose-response relationship between anesthetic drugs and electroencephalographic data because of the advantage of its high flexibility. However, as anesthetic doses increase, two pronounced pharmacodynamic plateaus appear in the dose-response curves of the processed EEG devices [9][10][11] . These biphasic dose-response curves suggest that the classical sigmoidal E max model cannot reflect these data, and thus a new pharmacodynamic model needs to be developed.…”

Section: Introductionmentioning

confidence: 99%

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Comparison between cerebral state index and bispectral index as measures of electroencephalographic effects of sevoflurane using combined sigmoidal Emax model

et al. 2011

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Aim:The cerebral state index (CSI) was recently introduced as an electroencephalographic monitor for measuring the depth of anesthesia. We compared the performance of CSI to the bispectral index (BIS) as electroencephalographic measures of sevoflurane effect using two combined sigmoidal E max models. Methods: Twenty adult patients scheduled for laparotomy were studied. After induction of general anesthesia, sevoflurane concentrations were progressively increased and then decreased over 70 min. An analysis of the BIS and CSI with the sevoflurane effect-site concentration was conducted using two combined sigmoidal E max models. Results: The BIS and CSI decreased over the initial concentration range of sevoflurane and then reached a plateau in most patients. A further increase in sevoflurane concentration produced a secondary plateau in the pharmacodynamic response. The CSI was more strongly correlated with effect-site sevoflurane concentration (R 2 =0.95±0.04) than the BIS was (R 2 =0.87±0.07) (P<0.05). The individual E max and C eff50 (effect-site concentration associated with 50% decrease from baseline to plateau) values for the upper and lower plateaus were significantly greater for BIS (12.7±7.3, 1.6±0.4, and 4.2±0.5, respectively) than for CSI (3.4±2.2, 1.2±0.4, and 3.8±0.5, respectively) (P<0.05). The remaining pharmacodynamic parameters for the BIS and CSI were similar. Conclusion: The overall performance of the BIS and CSI during sevoflurane anesthesia was similar despite major differences in their algorithms. However, the CSI was more consistent and more sensitive to changes in sevoflurane concentration, whereas the measured BIS seemed to respond faster. The newly developed combined E max model adequately described the clinical data, including the pharmacodynamic plateau.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison between cerebral state index and bispectral index as measures of electroencephalographic effects of sevoflurane using combined sigmoidal Emax model

et al. 2011

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“…In addition, the Narcotrend index can be used for calculations: the index is 100-0, and general anesthesia is within the range of 64-0. Validation studies that compared Narcotrend values with BIS values are available for propofol anesthesia [22][23][24] and also for inhalation anesthesia with desflurane and isoflurane [25,26]. High prediction probability for loss of verbal response and eyelash reflex and for opens eyes spontaneously was detected with Narcotrend monitor [27].…”

Section: Eeg-based Monitors Of Depth Of Anesthesiamentioning

confidence: 99%

Current Status of EEG-Based Depth-of-Consciousness Monitoring During General Anesthesia

Musialowicz

Lahtinen

2014

Curr Anesthesiol Rep

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Monitoring the level of consciousness during general anesthesia with processed electroencephalogram (EEG) monitors has become an almost routine practice in the operating room, despite ambiguous research results regarding its potential benefits. For the patient as well as the anesthesiologist, the primary concern with respect to general anesthesia is that there will be a lack of awareness and recall during surgery. Using EEG signals to monitor the depth of anesthesia should reduce the incidence of intraoperative awareness, lead to a reduction in drug consumption, prevent anesthesia-related adverse events, and enable faster recovery. These benefits have been associated with depth-of-anesthesia monitoring in small clinical trials, but larger studies of EEG-based monitoring have failed to confirm the results of the smaller studies. The results of recent studies that investigated the emergence of consciousness after general anesthesia and the mechanism of action of anesthetic drugs on the central nervous system may help us to understand the limitations of EEG-based monitors and why they do not perform better in large clinical trials. In this article, we review the current status of monitoring the hypnotic component of general anesthesia and discuss the results of recent studies and guidelines that pertain to depth-of-anesthesia monitoring.

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“…This might possibly result in less accurate functioning at specific anesthetic states, e.g., causing plateau levels or other less reactive periods in the index at specific levels of the hypnotic component of anesthesia. 12,13 A different method for system identification using neural networks and fuzzy logic has been applied increasingly in medical technology, where it provides decision support and expert systems with powerful reasoning capabilities. 14,15 Fuzzy reasoning allows the implementation of very complex processes, where a simple mathematical model cannot be obtained.…”

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confidence: 99%

Cerebral State Index during Propofol Anesthesia

Jensen

Litvan²,

Revuelta

et al. 2006

Anesthesiology

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Background The objective of this study was to prospectively test the Cerebral State Index designed for measuring the depth of anesthesia. The Cerebral State Index is calculated using a fuzzy logic combination of four subparameters of the electroencephalographic signal. The performance of the Cerebral State Index was compared with that of the Bispectral Index and the A-Line ARX Index. Methods This study applied raw data from two previously published clinical protocols. The patients in protocol 1 were given a continuous propofol infusion, 300 ml/h, until 80% of burst suppression occurred. In protocol 2, a stepwise increased target-controlled infusion of propofol was administered to patients until loss of response to noxious stimuli while the Observer's Assessment of Alertness and Sedation was registered every 4 min. The Cerebral State Index was calculated off-line from the recorded electroencephalographic data. The Spearman rank correlation coefficient between electronic indices and the effect site concentration of propofol was calculated along with the prediction probability of each index to predict the Observer's Assessment of Alertness and Sedation level. Results The Spearman rank correlation coefficients between the Cerebral State Index, Bispectral Index, and A-Line ARX Index and the propofol effect site concentration were -0.94, -0.89, and -0.82, respectively, in protocol 1, whereas the prediction probability values between the Cerebral State Index, Bispectral Index, and A-Line ARX Index and the Observer's Assessment of Alertness and Sedation score in protocol 2 were 0.92, 0.93, and 0.91, respectively. Conclusion The Cerebral State Index detects well the graduated levels of propofol anesthesia when compared with the propofol effect site concentration and the Observer's Assessment of Alertness and Sedation score.

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Application of Bispectral Index® and Narcotrend® Index to the Measurement of the Electroencephalographic Effects of Isoflurane with and without Burst Suppression

Abstract: The BIS and the Narcotrend index detected the electroencephalographic effects of isoflurane equally. Combining two fractional sigmoid Emax models adequately described the data before and after the onset of burst suppression.

Cited by 56 publications

References 15 publications

Comparison between cerebral state index and bispectral index as measures of electroencephalographic effects of sevoflurane using combined sigmoidal Emax model

Comparison between cerebral state index and bispectral index as measures of electroencephalographic effects of sevoflurane using combined sigmoidal Emax model

Current Status of EEG-Based Depth-of-Consciousness Monitoring During General Anesthesia

Cerebral State Index during Propofol Anesthesia

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