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Monitoring depth of anaesthesia: is it worth the effort?

Published online by Cambridge University Press:  23 December 2004

V. Bonhomme  and
P. Hans
V. Bonhomme
Affiliation:
Liege University Hospital, University Department of Anaesthesia and Intensive Care Medicine, CHR de la Citadelle, Liege, Belgium
P. Hans
Affiliation:
Liege University Hospital, University Department of Anaesthesia and Intensive Care Medicine, CHR de la Citadelle, Liege, Belgium
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Abstract

Summary

In this review paper, the authors critically analyse the use of a number of depth of anaesthesia monitors in light of the most recent literature and their own clinical experience. There appears to be increasing evidence that anaesthesia depth monitors reduce the incidence of unexpected intraoperative awareness and also that they improve the quality of anaesthesia. Proper use of these monitors necessitates background knowledge about the physiology of the loss of consciousness, the type of variable recorded and processed by the monitoring devices, the factors that might interfere with recording and the limits of use. The information provided by anaesthesia depth monitors is detailed and relationships with clinical practice are established to provide the reader with key features for optimal use of those monitors and correct interpretation of data. Practitioners and patient's knowledge and expectations regarding this matter, as well as the cost–benefit relationship are also discussed.

Keywords

ANAESTHESIA, GENERAL, monitoringELECTROENCEPHALOGRAPHY, Bispectral Index, entropyEVOKED POTENTIALS, AUDITORYCOST–BENEFIT ANALYSIS
Type
Review
Information
European Journal of Anaesthesiology , Volume 21 , Issue 6 , June 2004 , pp. 423 - 428
Copyright
2004 European Society of Anaesthesiology

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References

Liu WH, Thorp TA, Graham SG, Aitkenhead AR. Incidence of awareness with recall during general anaesthesia. Anaesthesia 1991; 46:435–437.Google Scholar
Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anaesthesia: a prospective case study. Lancet 2000; 355: 707–711.Google Scholar
Leslie K, Lee L, Myles PS, Lerch N, Fiddes C. Patients' knowledge of and attitudes towards awareness and depth of anaesthesia monitoring. Anaesth Intens Care 2003; 31: 63–68.Google Scholar
Sebel PS, Bowdle A, Ghoneim MM, Rampil IJ, Padilla RE. The incidence of awareness during anesthesia: a multicenter U. S. study. Anesthesiology 2003; 99: A360.Google Scholar
Schneider G, Sebel PS. Monitoring depth of anaesthesia. Eur J Anaesthesiol 1997; 15: 21–28.Google Scholar
Bonhomme V, Fiset P, Meuret P, et al. Propofol anesthesia and cerebral blood flow changes elicited by vibrotactile stimulation: a positron emission tomography study. J Neurophysiol 2001; 85: 1299–1308.Google Scholar
Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology 1998; 89: 980–1002.Google Scholar
Johansen JW, Sebel PS. Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology 2000; 93: 1336–1344.Google Scholar
Luginbuhl M, Wuthrich S, Petersen-Felix S, Zbinden AM, Schnider TW. Different benefit of bispectal index (BIS™) in desflurane and propofol anesthesia. Acta Anaesthesiol Scand 2003; 47: 165–173.Google Scholar
Lehmann A, Karzau J, Boldt J, Thaler E, Lang J, Isgro F. Bispectral index-guided anesthesia in patients undergoing aortocoronary bypass grafting. Anesth Analg 2003; 96: 336–343.Google Scholar
Puri GD, Murthy SS. Bispectral index monitoring in patients undergoing cardiac surgery under cardiopulmonary bypass. Eur J Anaesthesiol 2003; 20: 451–456.Google Scholar
Forestier F, Hirschi M, Rouget P, et al. Propofol and sufentanil titration with the bispectral index to provide anesthesia for coronary artery surgery. Anesthesiology 2003; 99: 334–346.Google Scholar
Gurses E, Sungurtekin H, Tomatir E, Dogan H. Assessing propofol induction of anesthesia dose using bispectral index analysis. Anesth Analg 2004; 98: 128–131.Google Scholar
Kazama T, Morita K, Ikeda T, Kurita T, Sato S. Comparison of predicted induction dose with predetermined physiologic characteristics of patients and with pharmacokinetic models incorporating those characteristics as covariates. Anesthesiology 2003; 98: 299–305.Google Scholar
Guignard B, Menigaux C, Dupont X, Fletcher D, Chauvin M. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg 2000; 90: 161–167.Google Scholar
Detsch O, Schneider G, Kochs E, Hapfelmeier G, Werner C. Increasing isoflurane concentration may cause paradoxical increases in the EEG bispectral index in surgical patients. Br J Anaesth 2000; 84: 33–37.Google Scholar
Muncaster AR, Sleigh JW, Williams M. Changes in consciousness, conceptual memory, and quantitative electroencephalographical measures during recovery from sevoflurane- and remifentanil-based anesthesia. Anesth Analg 2003; 96: 720–725.Google Scholar
Guignard B, Chauvin M. Bispectral index increases and decreases are not always signs of inadequate anesthesia. Anesthesiology 2000; 92: 903.Google Scholar
O'Connor MF, Daves SM, Tung A, Cook RI, Thisted R, Apfelbaum J. BIS monitoring to prevent awareness during general anesthesia. Anesthesiology 2001; 94: 520–522.Google Scholar
Myles PS, Leslie K, Forbes A, Chan M, McNeil J. A large randomized trial of BIS monitoring to prevent awareness in high risk patients: The B-Aware Trial. Anesthesiology 2003; 99: A320.Google Scholar
Johnson RW, Shore JE. Which is the better entropy expression for speech processing: – S log S or log S? IEEE Acoust Speech Signal Proc 1984; ASSP-32: 129–137.Google Scholar
Bruhn J, Ropcke H, Hoeft A. Approximate entropy as an electroencephalographic measure of anesthetic drug effect during desflurane anesthesia. Anesthesiology 2000; 92: 715–726.Google Scholar
Litvan H, Jensen EW, Revuelta M, et al. Comparison of auditory evoked potentials and the A-line ARX index for monitoring the hypnotic level during sevoflurane and propofol induction. Acta Anaesthesiol Scand 2002; 46: 245–251.Google Scholar
Litvan H, Jensen EW, Galan J, et al. Comparison of conventional averaged and rapid averaged, autoregressive-based extracted auditory evoked potentials for monitoring the hypnotic level during propofol induction. Anesthesiology 2002; 97: 351–358.Google Scholar
Ge SJ, Zhuang XL, Wang YT, Wang ZD, Chen SL, Li HT. Performance of the rapidly extracted auditory evoked potentials index to detect the recovery and loss of wakefulness in anesthetized and paralyzed patients. Acta Anaesthesiol Scand 2003; 47: 466–471.Google Scholar
Ge SJ, Zhuang XL, Wang YT, Wang ZD,Li HT. Changes in the rapidly extracted auditory evoked potentials index and the bispectral index during sedation induced by propofol or midazolam under epidural block. Br J Anaesth 2002; 89: 260–264.Google Scholar
Struys MM, Jensen EW, Smith W, et al. Performance of the ARX-derived auditory evoked potential index as an indicator of anesthetic depth: a comparison with bispectral index and hemodynamic measures during propofol administration. Anesthesiology 2002; 96: 803–816.Google Scholar
Maattanen H, Anderson R, Uusijarvi J, Jakobsson J. Auditory evoked potential monitoring with the AAITM-index during spinal surgery: decreased desflurane consumption. Acta Anaesthesiol Scand 2002; 46: 882–886.Google Scholar
Recart A, Gasanova I, White PF, et al. The effect of cerebral monitoring on recovery after general anesthesia: a comparison of the auditory evoked potential and bispectral index devices with standard clinical practice. Anesth Analg 2003; 97: 1667–1674.Google Scholar
Myles PS, Symons JA, Leslie K. Anaesthetists' attitudes towards awareness and depth-of-anaesthesia monitoring. Anaesthesia 2003; 58: 11–16.Google Scholar
Gan TJ, Ing RJ, de LD, Wright D, El Moalem HE, Lubarsky DA. How much are patients willing to pay to avoid intraoperative awareness? J Clin Anesth 2003; 15: 108–112.Google Scholar
Mortier E, Struys M, De Smet T, Versichelen L, Rolly G. Closed-loop controlled administration of propofol using bispectral analysis. Anaesthesia 1998; 53: 749–754.Google Scholar