Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-26T16:01:35.564Z Has data issue: false hasContentIssue false

Comparison of a new composite index based on midlatency auditory evoked potentials and electroencephalographic parameters with bispectral index (BIS) during moderate propofol sedation

Published online by Cambridge University Press:  07 July 2006

D. Hadzidiakos
Affiliation:
Charité – Universitaetsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Department of Anaesthesiology and Intensive Care Medicine, Berlin, Germany
S. Petersen
Affiliation:
Charité – Universitaetsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Department of Anaesthesiology and Intensive Care Medicine, Berlin, Germany
J. Baars
Affiliation:
Charité – Universitaetsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Department of Anaesthesiology and Intensive Care Medicine, Berlin, Germany
K. Herold
Affiliation:
Charité – Universitaetsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Department of Anaesthesiology and Intensive Care Medicine, Berlin, Germany
B. Rehberg
Affiliation:
Charité – Universitaetsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Department of Anaesthesiology and Intensive Care Medicine, Berlin, Germany
Get access

Abstract

Summary

Background and objective: Derived parameters of the electroencephalogram and auditory evoked potentials can be used to determine depth of anaesthesia and sedation. However, it is not known whether any parameter can identify the occurrence of awareness in individual patients. We have compared the performance of bispectral index and a new composite index derived from auditory evoked potentials and the electroencephalogram (AAI 1.61) in predicting consciousness, explicit and implicit memory during moderate sedation with propofol. Methods: Twenty-one patients with spinal anaesthesia received intraoperatively propofol at the age-corrected C50 for loss of consciousness and were presented test words via headphones. Bispectral index and AAI 1.61 (auditory evoked potentials, AEP-Monitor2) were recorded in parallel as well as the Observer's Assessment of Alertness/Sedation-score. Postoperatively, testing for explicit and implicit memory formation was performed. Results: Bispectral index and AAI 1.61 correlated well with loss of consciousness defined by an Observer's Assessment of Alertness/Sedation-score of 2 (identical PK of 0.87), but did not allow a prediction of postoperative explicit or implicit recall. Conclusions: Both bispectral index and AAI may be indices of depth of sedation rather than indicators of memory formation, which persists during propofol sedation even after loss of consciousness.

Type
Original Article
Copyright
2006 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

Bell JK, Laasch HU, Wilbraham L, England RE, Morris JA, Martin DF. Bispectral index monitoring for conscious sedation in intervention: better, safer, faster. Clin Radiol 2004; 59: 11061113.Google Scholar
Ekman A, Lindholm ML, Lennmarken C, Sandin R. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand 2004; 48: 2026.Google Scholar
Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-aware randomised controlled trial. Lancet 2004; 363: 17571763.Google Scholar
Ghoneim MM, Block RI. Learning and memory during general anesthesia: an update. Anesthesiology 1997; 87: 387410.Google Scholar
Mantzaridis H, Kenny GN. Auditory evoked potential index: a quantitative measure of changes in auditory evoked potentials during general anaesthesia. Anaesthesia 1997; 52: 10301036.Google Scholar
Schwender D, Kaiser A, Klasing S, Peter K, Poppel E. Midlatency auditory evoked potentials and explicit and implicit memory in patients undergoing cardiac surgery. Anesthesiology 1994; 80: 493501.Google Scholar
Thornton C, Barrowcliffe MP, Konieczko KMet al. The auditory evoked response as an indicator of awareness. Br J Anaesth 1989; 63: 113115.Google Scholar
Drummond JC. Monitoring depth of anesthesia: with emphasis on the application of the bispectral index and the middle latency auditory evoked response to the prevention of recall. Anesthesiology 2000; 93: 876882.Google Scholar
Schnider TW, Minto CF, Shafer SLet al. The influence of age on propofol pharmacodynamics. Anesthesiology 1999; 90: 15021516.Google Scholar
Vereecke HE, Vasquez PM, Jensen EWet 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: 500507.Google Scholar
Kruger T. Normative values for the completion of German wordstems. Eine Normierung der Ergänzung deutscher Wortanfänge zu Substantiven mit fünf oder sechs Buchstaben. Sprache & Kognition 1998; 17: 5172.Google Scholar
Meier B, Eckstein DJ. German material for studying implicit and explicit memory with the word stem completion task. Experimentiermaterial für die Untersuchung impliziter und expliziter Gedächtniseffekte mit der Wortanfangs-Ergänzungsaufgabe. Sprache & Kognition 1998; 17: 89105.Google Scholar
Chernik DA, Gillings D, Laine Het al. Validity and reliability of the Observer's Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol 1990; 10: 244251.Google Scholar
Brice DD, Hetherington RR, Utting JE. A simple study of awareness and dreaming during anaesthesia. Br J Anaesth 1970; 42: 535542.Google Scholar
Deeprose C, Andrade J, Varma S, Edwards N. Unconscious learning during surgery with propofol anaesthesia. Br J Anaesth 2004; 92: 171177.Google Scholar
Smith WD, Dutton RC, Smith NT. Measuring the performance of anesthetic depth indicators. Anesthesiology 1996; 84: 3851.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: 836847.Google Scholar
Iselin-Chaves IA, Flaishon R, Sebel PSet al. The effect of the interaction of propofol and alfentanil on recall, loss of consciousness, and the bispectral index. Anesth Analg 1998; 87: 949955.Google Scholar
Aceto P, Valente A, Gorgoglione M, Adducci E, De CG. Relationship between awareness and middle latency auditory evoked responses during surgical anaesthesia. Br J Anaesth 2003; 90: 630635.Google Scholar
Veselis RA, Reinsel RA, Feshchenko VA. Drug-induced amnesia is a separate phenomenon from sedation: electrophysiologic evidence. Anesthesiology 2001; 95: 896907.Google Scholar
Iselin-Chaves IA, Willems SJ, Jermann FC, Forster A, Adam SR, Van der LM. Investigation of implicit memory during isoflurane anesthesia for elective surgery using the process dissociation procedure. Anesthesiology 2005; 103: 925933.Google Scholar
Barr G, Anderson RE, Owall A, Jakobsson JG. Being awake intermittently during propofol-induced hypnosis: a study of BIS, explicit and implicit memory. Acta Anaesthesiol Scand 2001; 45: 834838.Google Scholar
Heinke W, Fiebach CJ, Schwarzbauer C, Meyer M, Olthoff D, Alter K. Sequential effects of propofol on functional brain activation induced by auditory language processing: an event-related functional magnetic resonance imaging study. Br J Anaesth 2004; 92: 641650.Google Scholar
Schwender D, Kaiser A, Klasing Set al. Anesthesia with flunitrazepam/fentanyl and isoflurane/fentanyl. Unconscious perception and mid-latency auditory evoked potentials. Anaesthesist 1994; 43: 289297.Google Scholar