title: Comparative evaluation of Narcotrend, Bispectral Index, and classical electroencephalographic variables during induction, maintenance, and emergence of a propofol/remifentanil anesthesia.
abstract: In the present study, we sought to compare the abilities of Narcotrend (NT) with the Bispectral Index (BIS) electroencephalographic system to monitor depth of consciousness immediately before induction of anesthesia until extubation during a standardized anesthetic. We investigated 26 patients undergoing laminectomy. Investigated states of anesthesia were: awake, loss of response, loss of eyelash reflex, steady-state anesthesia, first reaction, and extubation during emergence. NT, BIS, spectral edge frequency, median frequency, relative power in delta, theta, alpha, beta, and hemodynamics were recorded simultaneously. The ability of all variables to distinguish between awake versus loss of response, awake versus loss of eyelash reflex, awake versus steady-state anesthesia, steady-state anesthesia versus first reaction and extubation were analyzed with the prediction probability. Effects of remifentanil during propofol infusion were investigated with Friedman's and post hoc with Wilcoxon's test. Only NT and BIS were able to distinguish all investigated states accurately with a prediction probability >0.95. After start of remifentanil infusion, only hemodynamics changed statistically significantly (P < 0.05). NT and BIS are more reliable indicators for the assessment of anesthetic states than classical electroencephalographic variables and hemodynamics, whereas the analgesic potency of depth of anesthesia could not be detected by NT and BIS.
  
  
  CONCLUSIONS
  The modern electroencephalographic monitoring systems Narcotrend and Bispectral Index are more reliable indicators for the assessment of anesthetic states than classical electroencephalographic and hemodynamic variables to predict anesthetic conditions from before induction of anesthesia until extubation during a standardized anesthetic regime with propofol and remifentanil. The analgesic potency of depth of anesthesia could not be detected by Narcotrend and Bispectral Index.
authors.affiliation: Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany. guschmid@uke.uni-hamburg.de
authors.forename: Gunter N
authors.initials: GN
authors.lastname: Schmidt
authors.forename: Petra
authors.initials: P
authors.lastname: Bischoff
authors.forename: Thomas
authors.initials: T
authors.lastname: Standl
authors.forename: Gunnar
authors.initials: G
authors.lastname: Lankenau
authors.forename: Mathias
authors.initials: M
authors.lastname: Hilbert
authors.forename: Jochen
authors.initials: J
authors.lastname: Schulte Am Esch
mesh_terms: D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D017586:Diskectomy; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010880:Piperidines; D015742:Propofol; D000077208:Remifentanil
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol