A Randomized Controlled Trial Comparison of NeuroSENSE and Bispectral Brain Monitors During Propofol-Based Versus Sevoflurane-Based General Anesthesia.
BACKGROUND
NeuroSENSE is a depth of anesthesia monitor that uses automated electroencephalogram quantification. The Wavelet-based Anesthetic Value for Central Nervous System (WAVCNS) index calculated by this monitor is based on wavelet analysis of a normalized electroencephalogram signal in the γ-frequency band. The aim of this study was to determine the extent of disagreement between the Bispectral Index (BIS) and the WAVCNS index during propofol-based and sevoflurane-based maintenance of general anesthesia in a routine surgical population.


METHODS
Patients undergoing elective surgery were enrolled in the study and randomly assigned to receive either propofol or sevoflurane for the maintenance of anesthesia and remifentanil in both groups. Anesthesiologists were blinded to monitors in both groups. Discordance between the 2 monitors was assessed by the count of discrepancy in recommendation (DR) (type 1 defined as one parameter <40 and the other >60, or type 2 defined as BIS and WAVCNS values on different sides of a threshold [40 or 60]) and also by the proportion of agreement (P0) between WAVCNS and BIS, obtained every 5 seconds, in 3 categories of index (<40, 40-60, and >60).


RESULTS
The analyzed data set consisted of 22 patients (36,872 data pairs) in the propofol group and 24 patients (32,826 data pairs) in the sevoflurane group. The type 1 DR rarely occurred in both the groups (<1%); however, the median (interquartile range) type 2 DR was significantly more frequent in the propofol group (20.6% [7.0-36.9] vs 4.5% [2.3-12.4]; P = 0.0005). The median difference in P0 was 11.53% (95% confidence interval, 0.57-21.32). Major disagreement between WAVCNS index and BIS was related to the weight of burst suppression pattern for the index calculation.


CONCLUSIONS
Disagreement between BIS and NeuroSENSE during the maintenance of general anesthesia was worse in the propofol group than that in the sevoflurane groups. The disagreement increases during deep anesthesia or in the occurrence of burst suppression.
From the *Department of Anesthesiology, Hopital Foch, Suresnes, France; †Department of Anesthesiology, Hopital Foch, University Versailles Saint-Quentin en Yvelines, France; ‡Department of Anesthesiology and Intensive Care, Hopital Lariboisiere, Paris, France; §Clinical Epidemiology and Biostatistics U171, INSERM, Paris, France; ‖Department of Anesthesiology, Hopital Lariboisiere, University Paris Diderot, Paris, France; ¶NeuroWave Systems Inc., Cleveland Heights, Ohio; #Outcomes Research Consortium, Cleveland, Ohio; and **Department of Electroencephalography, Hopital Foch, Suresnes, France.
Julie
J
Bresson
Etienne
E
Gayat
Gracee
G
Agrawal
Thierry
T
Chazot
Ngai
N
Liu
Chantal
C
Hausser-Haw
Marc
M
Fischler
D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods / Q000592:standards*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D056805:Consciousness Monitors / Q000592:standards*; D004311:Double-Blind Method; D004569:Electroencephalography / Q000187:drug effects / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods / Q000592:standards*; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D000077149:Sevoflurane; D058067:Wavelet Analysis
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol