Efficacy of A-line™ AEP Monitor as a tool for predicting acceptable tracheal intubation conditions during sevoflurane anaesthesia

Alpiger, S.; Helbo-Hansen, Hans S.; Vach, Werner; Ørding, Helle

doi:10.1093/bja/aei111

Cited by 12 publications

(6 citation statements)

References 27 publications

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“…that AAI was one of the most sensitive variables of level of consciousness 21,[31][32][33][34][35][36] . The observations of others [37][38][39] showed the higher sensitivity of auditory evoked potentials in comparison to spontaneous electroencephalogram in evaluating the changes of consciousness.…”

Section: Discussionmentioning

confidence: 94%

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Szostakiewicz¹,

Rybicki²,

Tomaszewski³

2018

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Clinical monitoring is the most common method of adjusting the appropriate level of general anesthesia. However, episodes of intraoperative awareness (AWR) are still reported, suggesting that clinical observations may not be sufficient in some cases. The objective of this study was to compare the efficacy of clinical and instrumental neuromonitoring with auditory evoked potentials (AEP) in an intraoperative analysis of the proper level of general anesthesia. Methods. Patients scheduled for elective surgery were randomly divided into two groups. Subjects in the first group underwent intravenous, in the second group volatile anesthesia. The adequacy of anesthesia was analyzed using clinical parameters. All the participants were instrumentally monitored with the autoregressive AEP index (AAI). After the anesthesia, patients filled out a questionnaire on possible AWR. Results. Data of 208 patients (87 in the first, and 121 in the second group) were analyzed. Before surgery there were no changes in AAI values between groups (80 vs. 78, P=0.5192). The mean values of clinical parameters changed, but five minutes after the nociceptive stimuli. The mean values of AAI at analyzed time points were specific for general anesthesia. In patients under intravenous anesthesia, we found more episodes of too low (46/608 vs.15/847, P<0.000) anesthesia. One case of AWR was found in the TIVA group. Conclusions. AAI index is good indicator of patients' level of consciousness during general anesthesia. Standard clinical monitoring provides appropriate level of the procedure. However, it is insufficient during TIVA and does not prevent episodes of AWR.

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Section: Discussionmentioning

confidence: 94%

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Szostakiewicz¹,

Rybicki²,

Tomaszewski³

2018

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…AAI values are normally in the range 0-100. Generally, it is considered that AAI 60-100 represents the normal waking state, 40-60 represents the sleep state, 30-40 represents the light anesthesia state, <30 represents the clinical anesthesia state and <10 represents the deep anesthesia state (22). It has been suggested that AAI can much more sensitively reflect the depth of anesthesia than the bispectral index in Pro-fentanyl anesthesia (23).…”

Section: Discussionmentioning

confidence: 99%

Median effective concentration of remifentanil for the inhibition of laryngoscope-induced cardiovascular responses

ZhenHai

Wang

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The aim of this study was to calculate the median effective concentration (EC 50 ) of remifentanil (Rem) for the inhibition of laryngoscope-induced cardiovascular responses, and to observe its effects on the cardiovascular system and stress system. The study included 20 patients, who underwent time-scheduled vocal cord polyp resection with monitoring of heart rate (HR), mean blood pressure (MBP) and auditory evoked potential (AEP)-based A-line ARX Index (AAI). The Rem concentration was initially 5 ng/ml in the first patient, and the concentration selected for each subsequent patient was calculated from the previous case on the basis of whether or not cardiovascular reactions occurred. The HR, MBP and AAI at baseline, after the induction of anesthesia, and before and after the insertion of a self-retaining laryngoscope were recorded, with a change >15% recorded as a positive cardiovascular response. The EC 50 sequential method was used to calculate the EC 50 of Rem for the inhibition of laryngoscope-induced responses. Cortisol, interleukin-6 and blood glucose levels before and after laryngoscope insertion were also measured. The target-controlled concentrations for the 20 patients were as follows: 2 cases at 5 ng/ml, 6 cases at 4.2 ng/ml, 6 cases at 3.5 ng/ml, 4 cases at 2.9 ng/ml and 2 cases at 2.4 ng/ml. The EC 50 of Rem for the inhibition of laryngoscope-induced responses was 3.5 ng/ml with a 95% confidence interval (CI) of 3.47-3.60 ng/ml. A reasonable dose for inhibiting laryngoscope-induced responses was within the range 2.9-4.2 ng/ml. In conclusion, Rem exhibited an EC 50 of 3.5 ng/ml for the inhibition of laryngoscope-induced cardiovascular responses, with a 95% CI of 3.47-3.60 ng/ml, and a reasonable dose for the inhibition of such responses was 2.9-4.2 ng/ml.

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“…All these provide a continuous evaluation and quantification of the conscious level. They were used initially during anaesthesia in adults [25][26][27][28][29] and in children [30,31], and have subsequently started to be used in critically ill patients.…”

Section: Clinical Scalesmentioning

confidence: 99%

Monitoring sedation in the critically ill child

Lamas

López‐Herce

2010

Anaesthesia

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SummarySedation is an essential part of the management of the critically ill child, and its monitoring must be individualised and continuous in order to adjust drug doses according to the clinical state. There is no ideal method for evaluating sedation in the critically ill child. Haemodynamic variables have not been found to be useful. Clinical scales are useful when sedation is moderate, but are limited by their subjective nature, the use of stimuli, and the impossibility of evaluating profoundly sedated patients or those receiving neuromuscular blocking drugs; in addition, many of these scales have not been evaluated in children. The COMFORT scale is the most appropriate, as it was designed and validated for critically ill children requiring mechanical ventilation. Electroencephalography‐derived methods permit continuous monitoring, provide an early indication of changes in the level of sedation, and facilitate a rapid adjustment of medication. However, these methods were designed and validated for patients under anaesthesia and their results cannot be fully extrapolated to the critically ill patient; in addition, some of them have not been validated in small children and there is still little experience in critically ill children. The main indications for the use of these methods are in patients with deep sedation and/or neuromuscular blockade. The bispectral index is the most widely used method at the present time. Analysis and comparison of the efficacy of the different methods for evaluating sedation in the critically ill child is required.

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Efficacy of A-line™ AEP Monitor as a tool for predicting acceptable tracheal intubation conditions during sevoflurane anaesthesia

Abstract: AAI indicates the depth of anaesthesia necessary for acceptable endotracheal intubation conditions. Under the conditions of the present study, end-expiratory sevoflurane concentration was a better predictor and may turn out to be more useful in the clinical setting.

Cited by 12 publications

References 27 publications

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Non-instrumental clinical monitoring does not guarantee an adequate course of general anesthesia. A prospective clinical study

Median effective concentration of remifentanil for the inhibition of laryngoscope-induced cardiovascular responses

Monitoring sedation in the critically ill child

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