title: Evaluation of the aepEX™ monitor of hypnotic depth in pediatric patients receiving propofol-remifentanil anesthesia.
abstract: BACKGROUND
  The aepEX Plus monitor (aepEX) utilizes a mid-latency auditory evoked potential-derived index of depth of hypnosis (DoH).
  
  
  OBJECTIVE
  This observational study evaluates the performance of the aepEX as a DoH monitor for pediatric patients receiving propofol-remifentanil anesthesia.
  
  
  METHODS
  aepEX and BIS values were recorded simultaneously during surgery in three groups of 25 children (aged 1-3, 3-6 and 6-16 years). Propofol was administered by target-controlled infusion. The University of Michigan Sedation Scale (UMSS) was used to clinically assess the DoH during emergence. Prediction probability (P(k)) and receiver operating characteristics (ROC) analyses were performed to assess the accuracy of both DoH monitors. Nonlinear regression analysis was used to describe the dose-response relationships for the aepEX, the BIS, and propofol plasma concentrations (Cp).
  
  
  RESULTS
  The P(k) for the aepEX and BIS was 0.36 and 0.21, respectively (P = 0.010). ROC analysis showed an area under the curve of 0.77 and 0.88 for the aepEX and BIS, respectively (P = 0.644). At half-maximal effect (EC(50)), C(p) of 3.13 μg·ml(-1) and 3.06 μg·ml(-1) were observed for the aepEX and BIS, respectively. The r(2) for the aepEX and BIS was 0.53 and 0.82, respectively.
  
  
  CONCLUSIONS
  The aepEX performs comparable to the BIS in differentiating between consciousness and unconsciousness, while performing inferior to the BIS in terms of distinguishing different levels of sedation and does not correlate well with the C(p) in children receiving propofol-remifentanil anesthesia.
authors.affiliation: Department of Anesthesiology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands. y.m.cheung@erasmusmc.nl
authors.forename: Yuen M
authors.initials: YM
authors.lastname: Cheung
authors.forename: Gail P
authors.initials: GP
authors.lastname: Scoones
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stolker
authors.forename: Frank
authors.initials: F
authors.lastname: Weber
mesh_terms: D000465:Algorithms; D000577:Amides; D000763:Anesthesia, Caudal; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D002648:Child; D002675:Child, Preschool; D056805:Consciousness Monitors; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography / Q000187:drug effects; D001330:Electronic Data Processing; D005072:Evoked Potentials, Auditory / Q000187:drug effects; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009407:Nerve Block; D017711:Nonlinear Dynamics; D010880:Piperidines; D015742:Propofol; D012372:ROC Curve; D012044:Regression Analysis; D000077208:Remifentanil; D000077212:Ropivacaine
chemical_list: D000577:Amides; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D010880:Piperidines; D000077212:Ropivacaine; D000077208:Remifentanil; D015742:Propofol
keywords: adolescent; auditory/drug effects; children; consciousness monitors; evoked potentials; infant; preschool; propofol