Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-10T16:33:53.207Z Has data issue: false hasContentIssue false
  • English
  • Français

Performance of AEP Monitor/2-derived composite index as an indicator for depth of sedation with midazolam and alfentanil during gastrointestinal endoscopy

Published online by Cambridge University Press:  01 March 2007

Y.-Y. Huang ,
Y.-C. Chu ,
K.-Y. Chang ,
Y.-C. Wang ,
K.-H. Chan  and
M.-Y. Tsou
Y.-Y. Huang
Affiliation:
National Yang-Ming University, Taipei Veterans General Hospital & School of Medicine, Department of Anaesthesiology, Taipei, Taiwan, ROC Institute of Clinical Medicine, Taipei, Taiwan, ROC
Y.-C. Chu
Affiliation:
National Yang-Ming University, Taipei Veterans General Hospital & School of Medicine, Department of Anaesthesiology, Taipei, Taiwan, ROC
K.-Y. Chang
Affiliation:
National Yang-Ming University, Taipei Veterans General Hospital & School of Medicine, Department of Anaesthesiology, Taipei, Taiwan, ROC
Y.-C. Wang
Affiliation:
Division of Healthcare and Service, Department of Medicine, Taipei, Taiwan, ROC
K.-H. Chan
Affiliation:
National Yang-Ming University, Taipei Veterans General Hospital & School of Medicine, Department of Anaesthesiology, Taipei, Taiwan, ROC
M.-Y. Tsou
Affiliation:
National Yang-Ming University, Taipei Veterans General Hospital & School of Medicine, Department of Anaesthesiology, Taipei, Taiwan, ROC
Get access

Summary

Background and objective

The A-Line® auditory evoked potential index (AAI) (AEP Monitor/2, Danmeter A/S, Odense, Denmark) is a newly developed composite parameter representing the degree of hypnosis. We conducted a prospective, observational study to explore the performance and validity of the AAI during conventional sedation for gastrointestinal (GI) endoscopy.

Methods

Thirty adults of either sex, age <65, scheduled for combined oesophagogastroduodenoscopy (OGD) and colonoscopy under sedation with intravenous (i.v.) midazolam and alfentanil were enrolled. The sedative end-point was set at the Observer’s Assessment of Alertness/Sedation (OAA/S) score less than 4. An AEP Monitor/2 was used in all patients. AAI, sedation scores, heart rate (HR), blood pressure (BP) and SPO2 were recorded every 2 min up to the end of the procedure. Receiver operator characteristic analysis was used to test validity and to select optimal sedation.

Results

There was a significantly positive correlation between AAI and OAA/S scores (ρ = 0.886; P < 0.001). The AAI also showed significant differences between subsequent levels of sedation scores (P < 0.001). AAI greater than 54 indicated fully awake or minimal sedation and values between 54 and 42 were suggestive of moderate sedation. Values between 42 and 34 were associated with moderate to deep sedation and readings below 34 were associated with deep sedation. The relative risk of SPO2 < 95% for OAA/S = 2 compared with 3 was 15.98 (95% confidence interval (CI): 3.94–64.81).

Conclusions

AAI is an effective tool for monitoring sedation during GI endoscopy induced by i.v. midazolam and alfentanil.

Keywords

AUDITORY EVOKED POTENTIALSCONSCIOUS SEDATION; MONITORINGGASTROINTESTINAL ENDOSCOPYMIDAZOLAMALFENTANIL
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 3 , March 2007 , pp. 252 - 257
Copyright
Copyright © European Society of Anaesthesiology 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.American Society of Anesthesiologists Task Force. Practice guidelines for sedation and analgesia by non-anesthesiologists. A report by the American Society of Anesthesiologists Task Force on sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96: 1004–1017.CrossRefGoogle Scholar
2.Keeffe, EB. Sedation and analgesia for endoscopy. Gastroenterology 1995; 106: 932–934.CrossRefGoogle Scholar
3.Waring, JP, Baron, TH, Hirota, WK et al. . Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc 2003; 58: 317–322.CrossRefGoogle ScholarPubMed
4.Bower, AL, Ripepi, A, Dilger, J, Boparai, N, Brody, FJ, Ponsky, JL. Bispectral index monitoring of sedation during endoscopy. Gastointest Endosc 2000; 52: 192–196.CrossRefGoogle ScholarPubMed
5.Kurita, T, Doi, M, Katoh, T et al. . Auditory evoked potential index predicts the depth of sedation and movement in response to skin incision during sevoflurane anaesthesia. Anesthesiology 2001; 95: 364–370.CrossRefGoogle Scholar
6.Struys, MM, Jensen, EW, Smith, W et al. . Performance of the ARX-derived auditory evoked potential index as an indicator of anaesthetic depth: a comparison with bispectral index and hemodynamic measures during propofol administration. Anesthesiology 2002; 96: 803–816.CrossRefGoogle ScholarPubMed
7.Nishiyama, T, Hanaoka, K. The A-line ARX index may be a more sensitive detector of arousal than the bispectral index during propofol–fentanyl–nitrous oxide anaesthesia: a preliminary investigation. Can J Anaesth 2004; 51: 539–544.Google Scholar
8.Nishiyama, T, Matsukawa, T, Hanaoka, K. Is the ARX index a more sensitive indicator of anaesthetic depth than the bispectral index during sevoflurane/nitrous oxide anaesthesia? Acta Anaesthesiol Scand 2004; 48: 1028–1032.CrossRefGoogle Scholar
9.Ge, SJ, Zhuang, XL, Wang, YT, Wang, ZD, Li, HT. Changes in the rapidly extracted auditory evoked potentials index and the bispectral index during sedation induced by propofol or midazolam under epidural block. Br J Anaesth 2002; 89: 260–264.CrossRefGoogle ScholarPubMed
10.Nishiyama, T, Matsukawa, T, Hanaoka, K. A comparison of the clinical usefulness of three different electroencephalogram monitors: bispectral index, processed electroencephalogram, and Alaris auditory evoked potentials. Anesth Analg 2004; 98: 1341–1345.CrossRefGoogle ScholarPubMed
11.Vereecke, HE, Vasquez, PM, Jensen, EW et al. . New composite index based on midlatency auditory evoked potential and electroencephalographic parameters to optimize correlation with propofol effect site concentration: comparison with bispectral index and solitary used fast extracting auditory evoked potential index. Anesthesiology 2005; 103: 500–507.CrossRefGoogle ScholarPubMed
12.Chernik, DA, Gillings, D, Laine, H et al. . Validity and reliability of the Observer’s Assessment of Alertness/Sedation scale: study with intravenous midazolam. J Clin Psychopharmacol 1990; 10: 244–251.Google ScholarPubMed
13.Brouillette, DE, Leventhal, R, Kumar, S et al. . Midazolam versus diazepam for combined esophogastroduodenoscopy and colonoscopy. Dig Dis Sci 1989; 34: 1265–1271.CrossRefGoogle ScholarPubMed
14.Gajraj, RJ, Doi, M, Mantzaridis, H, Kenny, GNC. Comparison of bispectral EEG analysis and auditory evoked potentials for monitoring depth of anaesthesia during propofol anaesthesia. Br J Anaesth 1999; 82: 672–678.CrossRefGoogle ScholarPubMed
15.Chen, SC, Rex, DK. An initial investigation of bispectral monitoring as an adjunct to nurse-administered propofol sedation for colonoscopy. Am J Gastroenterol 2004; 99: 1081–1086.CrossRefGoogle ScholarPubMed
16.Litvan, H, Jensen, EW, Galan, J et al. . Comparison of conventional averaged and rapid averaged, autoregressive-based extracted auditory evoked potentials for monitoring the hypnotic level during propofol induction. Anesthesiology 2002; 97: 351–358.CrossRefGoogle ScholarPubMed
17.Weber, F, Zimmermann, M, Bein, T. The impact of acoustic stimulation on the AEP monitor/2 derived composite auditory evoked potential index under awake and anesthetized conditions. Anesth Analg 2005; 101: 435–439.CrossRefGoogle ScholarPubMed
18.Weber, F, Bein, T, Hobbhahn, J, Taeger, K. Evaluation of the Alaris auditory evoked potential index as indicator of anaesthetic depth in preschool children during induction of anaesthesia with sevoflurane and remifentanil. Anesthesiology 2004; 101: 294–298.CrossRefGoogle ScholarPubMed
19.Froehlich, F, Schwizer, W, Thorens, J et al. . Conscious sedation for gastroscopy: patient tolerance and cardiorespiratory parameters. Gastroenterology 1995; 108: 697–704.CrossRefGoogle ScholarPubMed
20.Holloway, AM, Logan, DA. Pain relief for outpatient colonoscopy: a comparison of alfentanil with fentanyl. Anaesth Intens Care 1990; 18: 210–213.CrossRefGoogle ScholarPubMed
21.Chokhavatia, S, Nguyen, L, Williams, R, Kao, J, Heavner, JE. Sedation and analgesia for gastrointestinal endoscopy. Am J Gastroenterol 1993; 88: 393–396.Google ScholarPubMed
22.Diab, FH, King, PD, Barthel, JS, Marshall, JB. Efficacy and safety of combined meperidine and midazolam for EDG sedation compared with midazolam alone. Am J Gastroenterol 1996; 91: 1120–1125.Google Scholar