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Auditory Evoked Potential Index and Bispectral IndexTM during Induction of Anesthesia with Propofol and Remifentanil



Auditory Evoked Potential Index and Bispectral IndexTM during Induction of Anesthesia with Propofol and Remifentanil



Anesthesiology Abstracts of Scientific Papers Annual Meeting ( ): Abstract No A-540



Background: Middle latency auditory evoked potentials (AEP) have been reported to be superior to the spontaneous Electroencephalogram (EEG) to discriminate between consciousness and unconsciousness. The waveforms can be difficult to interpret in clinical situations. For this reason, a new commercial AEP-monitor (A-line AEP monitor) was developed to calculate an index (AAI) using the amplitudes and latencies of the AEP automatically. The aim of the present study was to investigate the accurateness of AAI in comparison with Bispectral IndexTM (BISTM), classical electroencephalographic and hemodynamic parameters to predict unconsciousness and anesthesia. Methods: Following IRB approval and written informed consent we investigated 30 patients before spine surgery. AAI, BISTM, relative (%) delta, theta, alpha, beta, spectral edge frequency (SEF), median frequency (Median), mean arterial blood pressure, heart rate and oxygen saturation were obtained simultaneously during stepwise (1 mug/ml) induction of target controlled propofol concentration until 5 mug/ml, followed by a infusion of 0.3 mug/kg/min remifentanil over 10 minutes. Every minute the patients were asked to squeeze the observers hand. Prediction probability (Pk), receiver operating characteristic (ROC) and logistic regression were used to calculate the probability of predicting the conditions AWAKE, UNCONSCIOUSNESS (first loss of hand squeeze) and ANESTHESIA (propofol 5 mug/ml and 0.3 mg/kg/min remifentanil). Results: While a statistically significant difference between the conditions was observed for AAI, BISTM, MAP, Median and %alpha only AAI and BISTM were able to predict UNCONSCIOUSNESS and ANESTHESIA with better than 90% probability. No patient with an AAI smaller than 50 and a BISTM smaller than 79 was awake. The effective dose for predicting unconsciousness of 95% (ED95) was 29 for AAI, and 71 for BISTM. MAP was able to predict ANESTHESIA (Pk= 0.96) accurately, while it was a poor predictor for UNCONSCIOUSNESS (Pk= 0.69). The ED95 of MAP for ANESTHESIA was 72 mmHg. Conclusion: The modern electroencephalographic parameters AAI and BISTM were superior to the classical electroencephalographic and hemodynamic parameters to predict the considered anesthetic conditions. So far, there is no advantage of AAI over BISTM.

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