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

We have compared the auditory evoked potential index (AEPIndex) and bispectral index (BIS) for monitoring depth of anaesthesia in spontaneously breathing surgical patients. Twenty patients (aged 17-49 yr) undergoing day surgery were anaesthetized with computer-controlled infusions of propofol. The mean (SD and range) of each measurement was determined during consciousness and unconsciousness and at specific times during the perioperative period. Mean values for AEPIndex during consciousness and unconsciousness were 74.5 (SD 14.7) 36.7 (7.1), respectively. BIS had mean values of 89.5 (SD 4.6) during consciousness and 48.8 (16.4) during unconsciousness. AEPIndex and BIS were greater during consciousness compared with during unconsciousness. The average awake values of AEPIndex were significantly higher than all average values during unconsciousness but this was not the case for BIS. BIS increased gradually during emergence from anaesthesia and may therefore be able to predict recovery of consciousness at the end of anaesthesia. AEPIndex was more able to detect the transition from unconsciousness to consciousness.

[1]  P. Sebel,et al.  Recovery of Consciousness after Thiopental or Propofol: Bispectral Index and the Isolated Forearm Technique , 1997, Anesthesiology.

[2]  J. Jones Memory of intraoperative events , 1994, BMJ.

[3]  B. Bonke,et al.  Awareness and Recall during General Anesthesia: Facts and Feelings , 1993, Anesthesiology.

[4]  C P Heneghan,et al.  Effects of halothane or enflurane with controlled ventilation on auditory evoked potentials. , 1984, British journal of anaesthesia.

[5]  Aitkenhead,et al.  Awareness during anaesthesia: a review. , 1983, Annals of the Royal College of Surgeons of England.

[6]  N. T. Smith,et al.  A Multicenter Study of Bispectral Electroencephalogram Analysis for Monitoring Anesthetic Effect , 1997, Anesthesia and analgesia.

[7]  C. Doré,et al.  Effect of propofol on the auditory evoked response and oesophageal contractility. , 1989, British journal of anaesthesia.

[8]  L. Kearse,et al.  Bispectral analysis of the electroencephalogram during induction of anesthesia may predict hemodynamic responses to laryngoscopy and intubation. , 1994, Electroencephalography and clinical neurophysiology.

[9]  J. P. Payne Awareness and its medicolegal implications. , 1994, British journal of anaesthesia.

[10]  C Prys-Roberts,et al.  Anaesthesia: a practical or impractical construct? , 1987, British Journal of Anaesthesia.

[11]  C P Heneghan,et al.  Effect of etomidate on the auditory evoked response in man. , 1985, British journal of anaesthesia.

[12]  I. Russell Midazolam-alfentanil: an anaesthetic? An investigation using the isolated forearm technique. , 1993, British journal of anaesthesia.

[13]  L. Kearse,et al.  Bispectral Analysis of the Electroencephalogram Correlates with Patient Movement to Skin Incision during Propofol/Nitrous Oxide Anesthesia , 1994, Anesthesiology.

[14]  C P Heneghan,et al.  Effect of surgical stimulation on the auditory evoked response. , 1988, British journal of anaesthesia.

[15]  G N Kenny,et al.  Relationship between calculated blood concentration of propofol and electrophysiological variables during emergence from anaesthesia: comparison of bispectral index, spectral edge frequency, median frequency and auditory evoked potential index. , 1997, British journal of anaesthesia.

[16]  M. Alkire,et al.  Quantitative EEG Correlations with Brain Glucose Metabolic Rate during Anesthesia in Volunteers , 1998, Anesthesiology.

[17]  G N Kenny,et al.  Middle latency auditory evoked potentials during repeated transitions from consciousness to unconsciousness , 1996, Anaesthesia.

[18]  M. White,et al.  A portable target controlled propofol infusion system , 1992, International journal of clinical monitoring and computing.

[19]  N R Webster,et al.  Auditory evoked response and awareness: a study in volunteers at sub-MAC concentrations of isoflurane. , 1992, British journal of anaesthesia.

[20]  G N Kenny,et al.  Analysis of the EEG bispectrum, auditory evoked potentials and the EEG power spectrum during repeated transitions from consciousness to unconsciousness. , 1998, British journal of anaesthesia.

[21]  R. Blacher ON AWAKENING PARALYZED DURING SURGERY. A SYNDROME OF TRAUMATIC NEUROSIS , 1976 .

[22]  P. Cluitmans,et al.  Haemodynamic responses to incision and sternotomy in relation to the auditory evoked potential and spontaneous EEG. , 1996, British journal of anaesthesia.

[23]  C P Heneghan,et al.  Effect of isoflurane on the auditory evoked response in man. , 1987, British journal of anaesthesia.

[24]  Peter S. Sebel,et al.  Bispectral Analysis Measures Sedation and Memory Effects of Propofol, Midazolam, Isoflurane, and Alfentanil in Healthy Volunteers , 1997, Anesthesiology.

[25]  E. Pöppel,et al.  Effects of surgical stimulation on midlatency auditory evoked potentials during general anaesthesia with propofol/fentanyl, isoflurane/fentanyl and flunitrazepam/fentanyl , 1994, Anaesthesia.

[26]  G N Kenny,et al.  Auditory evoked potential index: a quantitative measure of changes in auditory evoked potentials during general anaesthesia , 1997, Anaesthesia.

[27]  R. R. Schultetus,et al.  Wakefulness during Cesarean Section after Anesthetic Induction with Ketamine, Thiopental, or Ketamine and Thiopental Combined , 1986, Anesthesia and analgesia.

[28]  A. C. Fisher,et al.  Validation of anesthetic depth by closed-loop control , 1993 .