title: Comparison of bispectral index and composite auditory evoked potential index for monitoring depth of hypnosis in children.
abstract: BACKGROUND
  In pediatric patients, the Bispectral Index (BIS), derived from the electroencephalogram, and the composite A-Line autoregressive index (cAAI), derived from auditory evoked potentials and the electroencephalogram, have been used as measurements of depth of hypnosis during anesthesia. The performance and reliability of BIS and cAAI in distinguishing different hypnotic states in children, as evaluated with the University of Michigan Sedation Scale, were compared.
  
  
  METHODS
  Thirty-nine children (aged 2-16 yr) scheduled to undergo elective inguinal hernia surgery were studied. For all patients, standardized anesthesia was used. Prediction probabilities of BIS and cAAI versus the University of Michigan Sedation Scale and sensitivity/specificity were calculated.
  
  
  RESULTS
  Prediction probabilities for BIS and cAAI during induction were 0.84 for both and during emergence were 0.75 and 0.74, respectively. At loss of consciousness, the median BIS remained unaltered (94 to 90; not significant), whereas cAAI values decreased (60 to 43; P < 0.001). During emergence, median BIS and cAAI increased from 51 to 74 (P < 0.003) and from 46 to 58 (P < 0.001), respectively. With respect to indicate consciousness or unconsciousness, 100% sensitivity was reached at cutoff values of 17 for BIS and 12 for cAAI. One hundred percent specificity was associated with a BIS of 71 and a cAAI of 60. To ascertain consciousness, BIS values greater than 78 and cAAI values above 52 were required.
  
  
  CONCLUSIONS
  BIS and cAAI were comparable indicators of depth of hypnosis in children. Both indices, however, showed considerable overlap for different clinical conditions.
authors.affiliation: Department of Anesthesiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands. h.blussevanoudalblas@erasmusmc.nl
authors.forename: Heleen J
authors.initials: HJ
authors.lastname: Blussé van Oud-Alblas
authors.forename: Jeroen W B
authors.initials: JW
authors.lastname: Peters
authors.forename: Tom G
authors.initials: TG
authors.lastname: de Leeuw
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Jan
authors.initials: J
authors.lastname: Klein
authors.forename: Frank
authors.initials: F
authors.lastname: Weber
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003243:Consciousness / Q000502:physiology; D004569:Electroencephalography; D005072:Evoked Potentials, Auditory / Q000502:physiology*; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D006990:Hypnosis; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D008297:Male; D011336:Probability; D014474:Unconsciousness / Q000503:physiopathology
chemical_list: D006993:Hypnotics and Sedatives