Comparison of bispectral EEG analysis and auditory evoked potentials for monitoring depth of anaesthesia during propofol anaesthesia

Gajraj, R. J.; Doi, Matsuyuki; Mantzaridis, H.; Kenny, G. N. C.

doi:10.1093/bja/82.5.672

Cited by 97 publications

(36 citation statements)

References 22 publications

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“…The higher stability of volatile anesthesia probably arises from the monitoring of end-tidal concentration of volatile anesthetic. Good correlation between AAI and concentration of both volatile 32,39,41,45,46 and intravenous anesthetics 21,37,38,47 during anesthesia was observed. At the end of surgery, together with decreasing concentration of volatile anesthetics, both AAI values and clinical parameters increased till the reversal of anesthesia.…”

Section: Discussionmentioning

confidence: 75%

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Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Szostakiewicz¹,

Rybicki²,

Tomaszewski³

2018

BIOMED PAP

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Background. Clinical monitoring is the most common method of adjusting the appropriate level of general anesthesia. However, episodes of intraoperative awareness (AWR) are still reported, suggesting that clinical observations may not be sufficient in some cases. The objective of this study was to compare the efficacy of clinical and instrumental neuromonitoring with auditory evoked potentials (AEP) in an intraoperative analysis of the proper level of general anesthesia. Methods. Patients scheduled for elective surgery were randomly divided into two groups. Subjects in the first group underwent intravenous, in the second group volatile anesthesia. The adequacy of anesthesia was analyzed using clinical parameters. All the participants were instrumentally monitored with the autoregressive AEP index (AAI). After the anesthesia, patients filled out a questionnaire on possible AWR. Results. Data of 208 patients (87 in the first, and 121 in the second group) were analyzed. Before surgery there were no changes in AAI values between groups (80 vs. 78, P=0.5192). The mean values of clinical parameters changed, but five minutes after the nociceptive stimuli. The mean values of AAI at analyzed time points were specific for general anesthesia. In patients under intravenous anesthesia, we found more episodes of too low (46/608 vs.15/847, P<0.000) anesthesia. One case of AWR was found in the TIVA group. Conclusions. AAI index is good indicator of patients' level of consciousness during general anesthesia. Standard clinical monitoring provides appropriate level of the procedure. However, it is insufficient during TIVA and does not prevent episodes of AWR.

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Section: Discussionmentioning

confidence: 75%

“…The observations of others [37][38][39] showed the higher sensitivity of auditory evoked potentials in comparison to spontaneous electroencephalogram in evaluating the changes of consciousness. During induction of anesthesia, together with decrease in AAI, in both groups also heart rate and systemic blood pressure decreased.…”

Section: Discussionmentioning

confidence: 92%

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Szostakiewicz¹,

Rybicki²,

Tomaszewski³

2018

BIOMED PAP

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“…In several studies AAI have been shown to reduce the amount of anaesthetics given and expedite immediate postoperative recovery as compared to standard practice [7] [8]. A number of studies have also demonstrated that the sensitivity and specificity for AAI is not perfect [9] [10] and fears have been raised that the incidence of awareness might even increase if the anaesthetist aims at an upper threshold value [11] [12].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Auditory Evoked Potential Monitoring for Anaesthesia Depth and Utilization of Inhaled Isoflurane

Tewari¹,

Murthy²

2017

OJAnes

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Background: Hypnosis monitoring has been shown to reduce the incidence of awareness. A-line ARX-Index™ (AAI) derived from auditory evoked potentials (AEP) represents as a numerical variable depth of anaesthesia. Objectives: To study the efficacy of AEP as an indicator of anaesthetic depth and monitor intraoperative awareness in neurosurgical patients by using the AAI scale. Design: Prospective cohort study is used. Setting: The study is in Neurosurgical centre of Tertiary care hospital. Participants: Neurosurgical patients requiring general anaesthesia with duration of surgery between 90 -150 minutes were enrolled for the study. Intervention: Patients in Group 1 (control) were monitored by conventional methods. Patients in Group 2 (study) underwent intraoperative monitoring by using the AEP monitor. Primary outcome: To study the efficacy of AEP monitoring and AAI index for monitoring the depth of anaesthesia and reducing the incidence of awareness. Results: There was no significant difference in the intraoperative haemodynamic responses measured between the two study groups (p > 0.5). There was no significant difference in the identification of intraoperative awareness by using conventional parameters between the two groups (p > 0.5). There was also a significantly faster time to recovery for patients in Group 2 (p < 0.05). Conclusion: Hypnosis monitoring using AEP monitor/AAI in neurosurgical patients under general anaesthesia did not show any significant difference in haemodynamic response and intraoperative awareness but had significant lower consumption of volatile anaesthetic with cost sparing effect and a faster recovery time as compared to conventional monitoring.

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“…The BIS values in our sample were generally lower than is recommended for surgical anaesthesia [11] and low in comparison with other adult studies. Mean intra-operative BIS has ranged from 32.4 to 72 [16][17][18][19][20][21][22][23][24][25] and median BIS has ranged from 36 to 48 [26][27][28][29], none as low as the mean of 28.1 and the median of 25.4 in our patients, with the exception of two trials, one where relatively high doses of anaesthetic were used to control haemodynamic changes [25] and another where there was little surgical stimulation [20] and the mean intra-operative BIS was 42-72. A recent study of 164 patients undergoing a variety of major and minor surgical procedures found BIS < 40 for 26 (22)% of the BIS-guided TCI maintenance of anaesthesia (mean (SD)) compared to 88.8 (19.75)% for our sample [18].…”

Section: Discussionmentioning

confidence: 99%

Bispectral index values during elective rigid bronchoscopy: a prospective observational pilot study

et al. 2007

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SummaryRigid bronchoscopy is associated with a high incidence of haemodynamic disturbance and awareness under anaesthesia. Anaesthetic agents are given both to attenuate the sympathetic response to bronchoscopy and to prevent awareness. Use of the Bispectral index to guide anaesthesia has shown to reduce awareness and improve recovery times from general anaesthesia. We undertook a prospective observational study of BIS values in 50 patients during routine anaesthesia for rigid bronchoscopy. BIS values were found to be between 40-60 during bronchoscopy for only 0.5% of the time (0-11.5% [0-98.7%]), median (interquartile range [range]). Patients had a BIS < 40 for 99.6% (87.9-100% [0-100%]) of the duration of bronchoscopy. We identified one case of possible awareness. Few of our patients undergoing general anaesthesia for rigid bronchoscopy had BIS scores in the suggested range of between 40 and 60. BIS < 40 was more frequent than in previous studies of different surgical populations. There was no difference in the BIS values of patients anaesthetised with intermittent boluses or target controlled infusions of propofol.

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Comparison of bispectral EEG analysis and auditory evoked potentials for monitoring depth of anaesthesia during propofol anaesthesia

Cited by 97 publications

References 22 publications

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Intraoperative Auditory Evoked Potential Monitoring for Anaesthesia Depth and Utilization of Inhaled Isoflurane

Bispectral index values during elective rigid bronchoscopy: a prospective observational pilot study

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