Evaluation of bispectral index and auditory evoked potentials for hypnotic depth monitoring during balanced xenon anaesthesia compared with sevoflurane

Fahlenkamp, Astrid; Peters, David M.; Biener, Ingeborg; Billoët, C.; Apfel, C. C.; Rossaint, Rolf; Coburn, Mark

doi:10.1093/bja/aeq163

Cited by 23 publications

(17 citation statements)

References 43 publications

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“…The higher stability of volatile anesthesia probably arises from the monitoring of end-tidal concentration of volatile anesthetic. Good correlation between AAI and concentration of both volatile 32,39,41,45,46 and intravenous anesthetics 21,37,38,47 during anesthesia was observed. At the end of surgery, together with decreasing concentration of volatile anesthetics, both AAI values and clinical parameters increased till the reversal of anesthesia.…”

Section: Discussionmentioning

confidence: 75%

“…Mean values of AAI after reversal of anesthesia was 60 in both groups, similarly to values observed before the induction of anesthesia. Because there was a good correlation between the level of conscience and AAI, use of neuromonitoring during anesthesia makes the prediction of the time of recovery over anesthesia more simple 39,41,46,47 and can reduce period between end of anesthesia and extubation 22,27,31,48,49 . The episodes of intraoperative awareness were surveyed using a questionnaire based on the work of Brice 29 , because of its efficacy and large number of studies 50 .…”

Section: Discussionmentioning

confidence: 99%

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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: 75%

Section: Discussionmentioning

confidence: 99%

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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“…Since there are no age-adapted MAC values for xenon available, we presumed that the used gas concentrations were equivalent. They match the concentrations used in other studies [37,38]. …”

Section: Discussionmentioning

confidence: 99%

Early cognitive function, recovery and well-being after sevoflurane and xenon anaesthesia in the elderly: a double-blinded randomized controlled trial

Cremer

Stoppe

Fahlenkamp

et al. 2011

Medical Gas Research

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BackgroundThe postoperative cognitive function is impaired in elderly patients after general anaesthesia. The fast recovery after xenon anaesthesia was hypothesized to be advantageous in this scenario. We compared early postoperative cognitive function after xenon and sevoflurane anaesthesia in this study.MethodsThe study was approved by the local ethics committee and written informed consent was obtained from each patient. Patients aged 65-75 years (ASA I-III) scheduled for elective surgery (duration 60-180 min) were enrolled. Investigators performing cognitive testing and patients were blinded towards allocation to either xenon or sevoflurane anaesthesia. Baseline assessment of cognitive function was carried out 12-24 h before the operation. The results were compared to follow-up tests 6-12 and 66-72 h after surgery. Primary outcome parameter was the subtest "Alertness" of the computerized Test of Attentional Performance (TAP). Secondary outcome parameters included further subtests of the TAP, several Paper-Pencil-Tests, emergence times from anaesthesia, modified Aldrete scores and patients' well-being.Results40 patients were randomized and equally allocated to both groups. No significant differences were found in the TAP or the Paper-Pencil-Tests at 6-12 and 66-72 h after the operation. All emergence times were faster after xenon anaesthesia. The modified Aldrete scores were significantly higher during the first hour in the xenon group. No difference in well-being could be detected between both groups.ConclusionsThe results show no difference in the incidence of postoperative cognitive dysfunction (POCD) after xenon or sevoflurane anaesthesia. Emergence from general anaesthesia was faster in the xenon group.

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“…However, we would like to note that the available evidence suggests that the BIS is a suitable instrument for assessing depth of xenon anesthesia. Fahlenkamp et al showed that during balanced xenon anesthesia, BIS values correlated well with the clinical assessment of hypnotic depth and were within the range recommended for adequate anesthesia. Stoppe et al demonstrated that the BIS showed a similar response to sevoflurane as to xenon anesthesia.…”

Section: Discussionmentioning

confidence: 93%

The effect of xenon‐augmented sevoflurane anesthesia on intraoperative hemodynamics and early postoperative neurocognitive function in children undergoing cardiac catheterization: A randomized controlled pilot trial

Devroe

Lemiere

Hese

et al. 2018

Pediatric Anesthesia

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Evaluation of bispectral index and auditory evoked potentials for hypnotic depth monitoring during balanced xenon anaesthesia compared with sevoflurane

Abstract: During surgery, xenon/remifentanil anaesthesia can be monitored using BIS and cAAI. However, cAAI values changed after about 1 h of anaesthesia. Further studies will be needed to address the question whether auditory signal processing is altered during extended xenon exposure.

Cited by 23 publications

References 43 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

Early cognitive function, recovery and well-being after sevoflurane and xenon anaesthesia in the elderly: a double-blinded randomized controlled trial

The effect of xenon‐augmented sevoflurane anesthesia on intraoperative hemodynamics and early postoperative neurocognitive function in children undergoing cardiac catheterization: A randomized controlled pilot trial

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