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Cerebral state monitor, a new small handheld EEG monitor for determining depth of anaesthesia: a clinical comparison with the bispectral index during day-surgery

Published online by Cambridge University Press:  24 January 2006

R. E. Anderson  and
J. G. Jakobsson
R. E. Anderson
Affiliation:
Karolinska Hospital, Department of Cardiothoracic Anaesthetics and Intensive Care, Stockholm, Sweden
J. G. Jakobsson
Affiliation:
The Karolinska Institute, Department of Anaesthesiology and Intensive Care, Stockholm, Sweden
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Extract

Summary

Background and objective: The cerebral state index (CSI™) derived from a new small handheld electroencephalogram monitor was studied during routine day surgical anaesthesia titrated according to the bispectral index (BIS™). The objective was to determine the degree of agreement between the two monitors. Methods: Anaesthesia was induced with propofol and fentanyl (0.1 mg) in 38 patients undergoing general anaesthesia for routine day-surgery. Maintenance anaesthesia (sevoflurane (20/38), desflurane (10/38) or propofol (8/38)) titrated by BIS XP (Aspect Medical, Natwick, MA, USA) and BIS and CSI (cerebral State Monitor, Danmeter; Odense, Denmark) index values were recorded every minute. No patient received muscle relaxation. Observer's Assessment of Alertness/Sedation rating scale was used to assess level of sedation. Results: Pair-wise recordings (914) of CSI and BIS were collected. The indices showed similar pattern and decreased with increasing level of sedation, however with large ranges for each level of sedation. Median indices were similar during surgery (BIS: 50 (14–89); CSI: 51 (7–88)) and both indices increased (P < 0.01) when minor movements occurred (BIS 65 (40–83); CSI 67 (40–89)). During maintenance of anaesthesia CSI > 20% from BIS-index in 24% of readings, and on rare occasions CSI indices deviated >100% from the BIS reading. When BIS < 40, CSI decreased slower than BIS and with wider spreading. Conclusions: When used for day-surgery anaesthesia without muscle relaxation, CSI and BIS show similar patterns and numerical values but with the incidence of occasionally large discrepancies between pair-wise readings. Which monitor is the more dependable remains to be established and cannot be implied from this initial explorative study.

Keywords

ANAESTHESIA GENERALAWARENESSMONITORING, depth of anaesthesia, bispectral index, cerebral state indexSURGERY AMBULATORYANAESTHETICS, propofol, sevoflurane, desflurane
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 3 , March 2006 , pp. 208 - 212
Copyright
© 2006 European Society of Anaesthesiology

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References

Chernik DA, Gillings D, Laine H et al. Validity and reliability of the Observer's Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psycho-pharmacol 1990; 10: 244–251.Google Scholar
Glass PS, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology 1997; 86: 836–847.Google Scholar
Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology 1998; 89: 980–1002.Google Scholar
Schneider G, Mappes A, Neissendorfer T, Schabacker M, Kuppe H, Kochs E. EEG-based indices of anaesthesia: correlation between bispectral index and patient state index? Eur J Anaesth 2004; 21: 6–12.Google Scholar
Johansen J, Sebel P, Fisher D. Development and clinical application of electroencephalographic bispectral monitoring. Anesthesiology 2000; 93: 433–443.Google Scholar
Assareh H, Anderson RE, Uusijarvi J, Jakobsson J. Sevoflurane requirements during ambulatory surgery: a clinical study with and without AEP-index guidance. Acta Anaesthesiol Scand 2002; 46: 495–499.Google Scholar
Liu J, Singh H, White PF. Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg 1997; 84: 185–189.Google Scholar
Barr G, Anderson RE, Jakobsson J. A study of bispectral analysis and auditory evoked potential indices during propofol-induced hypnosis in volunteers. Anaesthesia 2001; 56: 888–893.Google Scholar
Kearse L, Rosow C, Zaslavsky A, Connors P, Dershwitz M, Denman W. Bispectral analysis of the encephalogram predicts conscious processing of information during propofol sedation and hypnosis. Anesthesiology 1998; 89: 25–34.Google Scholar
Degoute CS, Macabeo C, Dubreuil C, Duclaux R, Banssillon V. EEG bispectral index and hypnotic component of anaesthesia-induced by sevoflurane: comparison between children and adults. Br J Anaesth 2001; 86: 209–212.Google Scholar
Katoh T, Suzuki A, Ikeda K. Electroencephalographic derivatives as a tool for predicting the depth of sedation and anesthesia induced by sevoflurane. Anesthesiology 1998; 88: 642–650.Google Scholar
Barr G, Anderson RE, Owall A, Jakobsson JG. Effects on the bispectral index during medium–high dose fentanyl induction with or without propofol supplement. Acta Anaesthesiol Scand 2000; 44: 807–811.Google Scholar
Rampil IJ, Kim JS, Lenhardt R et al. Bispectral EEG index during nitrous oxide administration. Anesthesiology 1998; 89: 671–677.Google Scholar
Barr G, Jakobsson JG, Owall A, Anderson RE. Nitrous oxide does not alter bispectral index: study with nitrous oxide as a sole agent and as an adjunct to i.v. anaesthesia. Br J Anaesth 1999; 82: 827–830.Google Scholar
Kreuer S, Bruhn J, Larsen R, Bauer C, Wilhelm W. Comparison of BIS and AAI as measures of anaesthetic drug effect during desflurane–remifentanil anaesthesia. Acta Anaesthesiol Scand 2004; 48: 1168–1173.Google Scholar
Schwab HS, Seeberger MD, Eger EI II, Kindler CH, Filipovic M. Sevoflurane decreases bispectral index values more than does halothane at equal MAC multiples. Anesth Analg 2004; 99: 1723–1727.Google Scholar
Anderson RE, Barr G, Jakobsson JG. Cerebral state index during anaesthetic induction: a comparative study with propofol or nitrous oxide. Acta Anaesthesiol Scand 2005; 49: 750–753.Google Scholar
Vanluchene AL, Struys MM, Heyse BE, Mortier EP. Spectral entropy measurement of patient responsiveness during propofol and remifentanil.A comparison with the bispectral index. Br J Anaesth 2004; 93: 645–654.Google Scholar
Schmidt GN, Bischoff P, Standl T, Hellstern A, Teuber O, Schulte Esch J. Comparative evaluation of the Datex–Ohmeda S/5 entropy module and the bispectral index (R) monitor during propofol–remifentanil anesthesia. Anesthesiology 2004; 101: 1283–1290.Google Scholar
Ellerkmann RK, Liermann VM, Alves TM et al. Spectral entropy and bispectral index as measures of the electroencephalographic effects of sevoflurane. Anesthesiology 2004; 101: 1275–1282.Google Scholar
Alkire MT. Quantitative EEG correlations with brain glucose metabolic rate during anesthesia in volunteers. Anesthesiology 1998; 89: 323–333.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
Dahaba AA, Mattweber M, Fuchs A et al. The effect of different stages of neuromuscular block on the bispectral index and the bispectral index-XP under remifentanil/propofol anesthesia. Anesth Analg 2004; 99: 1141–1146.Google Scholar