Clarifying NAP5

Was NAP5 ‘NICE’ enough; where next for depth of anaesthesia monitors?

“…The methodology and this interpretation of NAP5's results have been analysed and critiqued in some detail in previous editorials . The NAP5 authors have attempted to clarify this figure by pointing out that it is merely the incidence of reported AAGA during the study period, rather than the total incidence – which was previously accepted by the international anaesthetic community as being approximately 1:1000 . This somewhat higher incidence is arrived at using ‘Brice’ methodology (post‐anaesthesia interview) and the NAP5 authors, whilst acknowledging the differences between the two methodologies, have also pointed out potential problems in deriving an incidence of awareness solely from Brice‐type questionnaires .…”

More than ‘fuzzy logic’ needed in promoting the use of depth of anaesthesia monitors

“…Secondly, they repeat some of the discussion about the reasons for differences between Brice and NAP5 incidences. We will not repeat those points, since we ourselves first made them and have expanded on them recently . Further thought and discussion are needed to understand the chasm between incidences reported by different methods (and to determine what is clinically relevant), but we challenge their assertion that the incidence of AAGA was “ previously accepted by the anaesthetic community as being ˜1:1000 ” .…”