[Comparison of an auditory evoked potentials index and a bispectral index versus clinical signs for determining the depth of anesthesia produced by propofol or sevoflurane].
OBJECTIVE
To evaluate an anesthetic depth index (ADI) obtained from auditory evoked potentials and a bispectral EEG index (BIS) in comparison with clinical assessment of anesthetic depth using the modified observer's assessment of awareness/sedation scale (MOAA/SS), for induction of anesthesia with propofol or sevoflurane as the only agent.


METHODS
The ADI and BIS were recorded simultaneously in this prospective study and compared to the MOAA/SS during the anesthetic induction of 26 adults undergoing elective heart surgery. Assignment of patients to two groups was random. Group A (n = 13) patients were induced with propofol (target dose 5 micrograms.ml-1 in 5 min). Induction in group B (n = 13) was with sevoflurane (8% tidal volume). A scheme of awake-sleeping-awake-sleeping was followed. The means of the two indexes were compared (Mann-Whitney test) one minute before the patient slept (awake) and one minute later (sleeping), and the evolution of the indexes was compared during awake/sleep and sleep/awake phase changes and while the patients were in a stable sleep phase. The sensitivity and specificity of each index was analyzed in function of the MOAA/SS. We also analyzed the time elapsing from the moment the patient fell asleep (MOAA/SS 2) until the two indexes reached published reference values (ADI = 38, BIS = 60).


RESULTS
After induction with propofol (group A) the ADI fell to 29.2 +/- 11.7 and the BIS fell to 63.5 +/- 13.4. After induction with sevoflurane (group B) the ADI fell to 33.8 +/- 14.9 and the BIS to 66.8 +/- 15. The ADI value that best discriminated between arousal and sleeping (sensitivity 100%) was 38; the BIS value that best discriminated was 60. The responses to sound in decibels (dB) during "awake/sleeping" and "sleeping/awake" phases were, respectively, -3.8 dB and -4.5 dB for the ADI and -1.5 dB and -0.8 dB for the BIS. With the patient in stable sleep, response to the two indexes was at -0.79 dB. In group A, the ADI detected MOAA/SS 2 significantly earlier (ADI 13.1 +/- 30 s; BIS 56 +/- 36 s; p < 0.05). No patient reported remembering the study period.


CONCLUSIONS
Monitoring anesthetic depth with the ADI or BIS was technically easy and effective for detecting whether patients were awake or sleeping. The ADI response was faster and identified awake/sleeping and sleeping/awake phase changes better than did the BIS.
Litvan
H
H
Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona. hlitvan@hsp.santpau.es
Jensen
E W
EW
Maestre
M L
ML
Galán
J
J
Campos
J M
JM
Fernández
J A
JA
Caminal
P
P
Villar Landeira
J M
JM
D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D006348:Cardiac Surgical Procedures; D003243:Consciousness / Q000187:drug effects*; D017558:Elective Surgical Procedures; D004569:Electroencephalography / Q000187:drug effects*; D005072:Evoked Potentials, Auditory / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D016343:Monitoring, Intraoperative / Q000379:methods*; D009460:Neurologic Examination; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D000077149:Sevoflurane; D014474:Unconsciousness / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol