Validation of the Index of Consciousness (IoC) during sedation/analgesia for ultrasonographic endoscopy

The level of consciousness of patients undergoing surgery evolves continuously as the effect of the anesthetic agents is counteracted by the surgical stimuli. The monitors of depth of anesthesia, based on the analysis of the electroencephalogram (EEG), have been progressively introduced into the daily practice to provide additional information about the state of the patient. In this work, the Index of Consciousness (IoC), a recent index which uses the information from EEG spectrum and symbolic dynamics through a fuzzy inference system, is introduced. The bispectral index BIS, a well-established index, is used to validate the IoC. A good correlation is found between both indexes. Furthermore, IoC presents a significantly higher prediction probability Pk of the level of sedation than BIS, and can thus be considered as an interesting measure of the level of consciousness.

[1]  M. Ramsay,et al.  Controlled Sedation with Alphaxalone-Alphadolone , 1974, British medical journal.

[2]  K. Leslie Introduction to cognitive activity during anaesthesia. , 2007, Best practice & research. Clinical anaesthesiology.

[3]  Paul F White,et al.  Effect of Auditory Evoked Potential Index Monitoring on Anesthetic Drug Requirements and Recovery Profile after Laparoscopic Surgery: A Clinical Utility Study , 2003, Anesthesiology.

[4]  M. Ghoneim,et al.  Incidence of and risk factors for awareness during anaesthesia. , 2007, Best practice & research. Clinical anaesthesiology.

[5]  C. Lennmarken,et al.  Neuromonitoring for awareness during surgery , 2004, The Lancet.

[6]  Arvi Yli-Hankala,et al.  Spectral Entropy Monitoring Is Associated with Reduced Propofol Use and Faster Emergence in Propofol–Nitrous Oxide–Alfentanil Anesthesia , 2005, Anesthesiology.

[7]  S L Shafer,et al.  Pharmacokinetics and Pharmacodynamics of Remifentanil: II. Model Application , 1997, Anesthesiology.

[8]  S. Henneberg,et al.  Autoregressive Modeling with Exogenous Input of Middle-Latency Auditory-Evoked Potentials to Measure Rapid Changes in Depth of Anesthesia , 1996, Methods of Information in Medicine.

[9]  Nassib G. Chamoun,et al.  An introduction to bispectral analysis for the electroencephalogram , 1994, Journal of Clinical Monitoring.

[10]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[11]  S L Shafer,et al.  The influence of age on propofol pharmacodynamics. , 1999, Anesthesiology.

[12]  S L Shafer,et al.  Influence of Age and Gender on the Pharmacokinetics and Pharmacodynamics of Remifentanil: I. Model Development , 1997, Anesthesiology.

[13]  Thomas W. Schnider,et al.  Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development , 1997 .

[14]  C. Lennmarken,et al.  Psychological consequences of awareness and their treatment. , 2007, Best practice & research. Clinical anaesthesiology.

[15]  Pk value does depend on the fineness of the observer scale , 2005, Acta anaesthesiologica Scandinavica.

[16]  Pere Caminal,et al.  Comparison of Conventional Averaged and Rapid Averaged, Autoregressive-based Extracted Auditory Evoked Potentials for Monitoring the Hypnotic Level during Propofol Induction , 2002, Anesthesiology.

[17]  I. Rampil A Primer for EEG Signal Processing in Anesthesia , 1998, Anesthesiology.

[18]  Awareness: practice, standards, and the law. , 2007, Best practice & research. Clinical anaesthesiology.

[19]  Warren D. Smith,et al.  Measuring the Performance of Anesthetic Depth Indicators , 1996, Anesthesiology.

[20]  J M Bland,et al.  Statistical methods for assessing agreement between two methods of clinical measurement , 1986 .

[21]  I J Rampil,et al.  Monitoring depth of anesthesia , 2001, Current opinion in anaesthesiology.

[22]  A. Yli-Hankala,et al.  Description of the Entropy™ algorithm as applied in the Datex‐Ohmeda S/5™ Entropy Module , 2004, Acta anaesthesiologica Scandinavica.