Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-28T14:08:11.307Z Has data issue: false hasContentIssue false
  • English
  • Français

Performance of bispectral index and auditory evoked potential monitors in detecting loss of consciousness during anaesthetic induction with propofol with and without fentanyl

Published online by Cambridge University Press:  28 January 2005

W. D. Mi ,
T. Sakai ,
T. Kudo ,
M. Kudo  and
A. Matsuki
W. D. Mi
Affiliation:
University of Hirosaki School of Medicine, Department of Anaesthesiology, Hirosaki-Shi, Japan Present address: Department of Anaesthesiology, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
T. Sakai
Affiliation:
University of Hirosaki School of Medicine, Department of Anaesthesiology, Hirosaki-Shi, Japan
T. Kudo
Affiliation:
University of Hirosaki School of Medicine, Department of Anaesthesiology, Hirosaki-Shi, Japan
M. Kudo
Affiliation:
University of Hirosaki School of Medicine, Department of Anaesthesiology, Hirosaki-Shi, Japan
A. Matsuki
Affiliation:
University of Hirosaki School of Medicine, Department of Anaesthesiology, Hirosaki-Shi, Japan
Get access

Extract

Summary

Background and objective: To investigate and compare the performance of bispectral index (BIS) and auditory evoked response index (AAI) in detecting the transition from consciousness to unconsciousness during anaesthesia induction by propofol, alone and in combination with fentanyl.

Methods: Anaesthesia was induced with either an intravenous infusion of 30 mg kg−1 h−1 of propofol plus 2 μg kg−1 of fentanyl (Group PF, n = 20) or an intravenous infusion of 30 mg kg−1 h−1 of propofol plus normal saline (Group P, n = 20). BIS, AAI and the doses of propofol administered were recorded at the end-point of unresponsiveness to verbal commands. The propofol plasma concentration was also measured.

Results: The propofol dose and plasma propofol concentration required to achieve loss of consciousness were significantly lower in patients pretreated with fentanyl (P < 0.001). The mean BIS value at loss of consciousness was significantly different between the two groups (74.10 in Group PF vs. 60.80 in Group P) (P < 0.001). However, no difference in the AAI was seen between the two groups at loss of consciousness (32.90 in Group PF vs. 31.80 in Group P) (P > 0.05). In both groups, the regression analysis values (r-values) between BIS and plasma propofol concentrations at the onset of unconsciousness were higher than those between AAI and propofol concentrations (0.553 vs. 0.180 in Group P; 0.432 vs. 0.308 in Group PF).

Conclusions: These results show that a fentanyl bolus is effective in augmenting the hypnotic effect of propofol during anaesthesia induction. AAI appears to be able to measure the transition from consciousness to unconsciousness at similar values, regardless of whether or not fentanyl pretreatment is used whereas the BIS values were not independent of fentanyl pretreatment. This suggests that AAI may be a better indicator of conscious status during propofol/fentanyl anaesthesia, where it appears to be independent of the anaesthesia regimen.

Keywords

ANAESTHESIA, inductionANAESTHETICS, intravenous, propofolANALGESICS, narcotic, fentanylMONITORING, bispectral index, auditory evoked potentials
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 10 , October 2004 , pp. 807 - 811
Copyright
© 2004 European Society of Anaesthesiology

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

Gajraj RJ, Doi M, Mantzaridis H, Kenny GN. Comparison of bispectral EEG analysis and auditory evoked potentials for monitoring depth of anaesthesia during propofol anaesthesia. Br J Anaesth 1999; 82: 672–678.Google Scholar
Davies FW, Mantzaridis H, Kenny GNC, Fisher AC. Middle latency auditory evoked potentials during repeated transitions from consciousness to unconsciousness. Anaesthesia 1996; 51: 107–113.Google Scholar
Heier T, Steen PA. Assessment of anaesthesia depth. Acta Anaesthesiol Scand 1996; 40: 1087–1100.Google Scholar
Gan TJ, Glass PS, Windsor A, et al. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. Anesthesiology 1997; 87: 808–815.Google Scholar
Doi M, Gajraj RJ, Mantzaridis H, Kenny G. 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. Br J Anaesth 1997; 78: 180–184.Google Scholar
Glass PS, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836–847.Google Scholar
Mi WD, Sakai T, Singh H, Kudo M, Matsuki A. Hypnotic endpoints vs. the bispectral index, 95% spectral edge frequency and median frequency during propofol infusion with or without fentanyl. Eur J Anaesth 1999; 16: 47–52.Google Scholar
Jensen EW, Nygaard M, Henneberg SW. On-line analysis of middle latency auditory evoked potentials (MLAEP) for monitoring depth of anaesthesia in laboratory rats. Med Eng Phys 1998; 20: 722–728.Google Scholar
Litvan H, Jensen EW, Revuelta M, et al. Comparison of auditory evoked potentials and the A-line ARX index for monitoring the hypnotic level during sevoflurane and propofol induction. Acta Anaesthesiol Scand 2002; 46: 245–251.Google Scholar
Struys MMRF, Jensen EW, Smith W, et al. Performance of the ARX-derived auditory evoked potential index as an indicator of anaesthetic depth. Anesthesiology 2002; 96: 803–816.Google Scholar
Mantzaridis H, Kenny GNC. Auditory evoked potential index: a quantitative measure of changes in auditory evoked potentials during general anaesthesia. Anaesthesia 1997; 52: 1030–1036.Google Scholar
Gajraj RJ, Doi M, Mantzaridis H, Kenny GN. Analysis of the EEG bispectrum, auditory evoked potentials and the EEG power spectrum during repeated transitions from consciousness to unconsciousness. Br J Anaesth 1998; 80: 46–52.Google Scholar
Iselin-Chaves IA, Moalem HEEI, Gan TJ, Ginsberg B, Glass PSA. Changes in the auditory evoked potentials and the bispectral index following propofol or propofol and alfentanil. Anesthesiology 2000; 92: 1300–1310.Google Scholar
Leslie K, Sessler D, Schroeder M, Walters K. Propofol blood concentration and bispectral index predict suppression of learning during propofol/epidural anesthesia in volunteers. Anesth Analg 1995; 81: 1269–1274.Google Scholar
Moffat AC, Murray AW, Fitch W. Opioid supplementation during propofol anaesthesia. Anaesthesia 1989; 44: 644–647.Google Scholar
Short TG, Plummer JL, Chui PT. Hypnotic and anaesthetic interactions between midazolam, propofol and alfentanyl. Br J Anaesth 1992; 69: 162–167.Google Scholar
Smith C, McEwan AI, Jhareri R. The interaction of fentanyl on the Cp50 of propofol for loss consciousness and skin incision. Anesthesiology 1994; 81: 820–828.Google Scholar
Bailey PL, Egan TD, Stanley TH. Intravenous opioid anesthetics. In: Miller RD, ed. Anaesthesia, 5th edn. Philadelphia, USA: Churchill Livingstone Inc., 2002: 273–376.
Mi WD, Sakai T, Takahashi S, Matsuki A. Haemodynamic and electroencephalograph responses to intubation during induction with propofol or propofol/fentanyl. Can J Anaesth 1998; 45: 19–22.Google Scholar
Absalom AR, Sutcliffe N, Kenny GNC. Effects of the auditory stimuli of an auditory potential system on level of consciousness, and on the bispectral index. Br J Anaesth 2001; 87: 778–780.Google Scholar