Clinical comparison of three different anaesthetic depth monitors during cardiopulmonary bypass.
The lack of a gold standard complicates the evaluation and comparison of anaesthetic depth monitors. This randomised study compares three different depth-of-anaesthesia monitors during cardiopulmonary bypass (CPB) at 34 degrees C with fentanyl/propofol anaesthesia adjusted clinically and blinded to the monitors. Coronary artery bypass grafting patients (n = 21) were randomly assigned to all three possible paired combinations of three monitors: Bispectral Index (Aspect Medical), AAI auditory evoked potential (Danmeter), Entropy (Datex-Ohmeda). Indices were manually recorded every 5 min during CPB. Agreement between paired indices was classified as good, non-, or disagreement. Anaesthesia was classed as adequate, inadequate, or excessive according to recommended index values. Of the 255 paired indices recorded, 62% showed good agreement, 33% showed non-agreement, and 5% showed disagreement. Using good agreement between two monitors as a gold standard, a quarter of the measurements indicate inappropriate anaesthetic depth monitoring during CPB with clinically titrated anaesthetic depth.
Tirén
C
C
Department of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital, Sweden.
Anderson
R E
RE
Barr
G
G
Owall
A
A
Jakobsson
J G
JG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019162:Anesthetics, Combined / Q000494:pharmacology; D018681:Anesthetics, General / Q000494:pharmacology*; D002315:Cardiopulmonary Bypass; D003243:Consciousness / Q000187:drug effects*; D004569:Electroencephalography / Q000187:drug effects; D019277:Entropy; D005072:Evoked Potentials, Auditory / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D015203:Reproducibility of Results
D019162:Anesthetics, Combined; D018681:Anesthetics, General